Conduct weekly multidisciplinary rounds with Midwest and West Coast care teams, reviewing patient goals and providing clinical oversight.
Serve as the designated reviewer for patient escalations, applying clinical judgment to prioritize and direct cases to appropriate next steps.
Alternate monthly care delivery education sessions with co-Medical Lead, developing and facilitating case-based learning for various roles.
Waymark is a mission-driven team transforming care for people with Medicaid benefits by partnering with communities, delivering technology-enabled, human-centered support. We're designing tools and systems that bring care directly to those who need it most – removing barriers and reimagining what’s possible in Medicaid healthcare delivery.
Assess referred concurrent denials and determine next steps for resolution.
Review medical record documentation to support denial management strategies.
Advocate for patients to ensure coverage and reimbursement.
They are currently looking for a Utilization Management Coordinator. By enhancing operational efficiencies and implementing educational initiatives, this role significantly impacts the financial and quality outcomes of healthcare delivery.
Oversee day‑to‑day clinical operations for UM, CM, and DM teams.
Ensure operational workflows meet productivity, quality, and turnaround time expectations.
Partner with the VP of Care Management on operational priorities and process improvements.
Personify Health created the first and only personalized health platform bringing health plan administration, holistic wellbeing solutions, and comprehensive care navigation together in one place. It serves employers, health plans, and health systems with data-driven solutions that reduce costs while actually improving health outcomes.
Lead financial health, retention, and strategic expansion for significant US Health Insurance client accounts.
Bridge high-level business goals with successful technical deployment of health data platforms.
Identify and qualify expansion opportunities, lead contract renewals, and maintain high client satisfaction.
Smile Digital Health provides a leading FHIR-based data liberation platform to collect and exchange healthcare data. The company is a growing technology firm with a culture focused on respect, inclusion, and empowering employees to bring their authentic selves to work.
Identify and manage changes to medical rules by reviewing policies, transmittals, and bulletins for revision, retirement, or addition.
Build and maintain Clinical Transaction Engine tables, assign CPT/HCPCS codes, and review national policies for integration into medical edits.
Independently prepare data editorials for production release, analyze coding trends, and resolve client issues forwarded by Compliance Support.
Experian is a global data and technology company that powers opportunities for people and businesses by redefining lending, preventing fraud, simplifying healthcare, and creating digital marketing solutions. With over 23,300 employees across 32 countries, it's a FTSE 100 company known for its innovative, people-first culture focused on inclusion and development.
Assess, plan, coordinate, and monitor patient care.
Develop, implement, and monitor individualized care plans.
Coordinate care across providers, facilities, and community resources.
Limitlessli specializes in recruiting, hiring, and managing high-caliber remote staff for dynamic and growing healthcare facilities. They connect clients with highly qualified professionals, offering tailored services to meet unique business needs, leveraging an extensive global network.
Provide project management and subject matter expertise to help Medicaid agencies design, develop, and implement waiver and state plan amendments.
Build relationships and communicate project status with client contacts, stakeholders, federal partners, and vendor contacts.
Oversee and mentor junior staff while participating in business development activities like writing blog posts and reviewing RFPs.
BerryDunn is a professional services firm providing tax, advisory, and consulting services to businesses, nonprofits, and government agencies. It is a client-centered, people-first firm recognized for its diverse, inclusive culture and focus on learning, development, and well-being.
Lead and nurture a dynamic team of clinical pharmacists and technicians.
Create and uphold robust policies and procedures for utilization management review.
Generate and deliver comprehensive reports on prior authorization metrics.
Judi Health is an enterprise health technology company providing solutions for employers and health plans, including pharmacy benefit management and health benefit management. Judi Health values diversity and provides equal employment opportunities to all employees and applicants.
Managing the overall care management of patient panel by leveraging experience, expertise, and knowledge in both the nursing field and value-based care operations.
Establishing trusting and empathetic relationships with patients and families to provide clinical and emotional support and foster collaboration throughout their care journey.
Serving as an advocate and community liaison for patients to ensure proper and timely resources and support while navigating the health care system and maintaining compliance with the primary care team’s/nephrologist’s treatment plan.
Evergreen Nephrology partners with nephrologists to transform kidney care through a value-based, person-centered, holistic, and comprehensive approach to kidney care. They are committed to improving patient outcomes and improving quality of life.
Guide healthcare providers through the reimbursement process, including prior authorizations and appeals.
Work with insurance companies and third-party administrators to address coverage issues.
Provide education regarding insurance benefits and financial assistance programs.
Amplity is a full-service go-to partner of biopharma companies that delivers flexible + specialized medical + commercial services. Amplity transforms how breakthrough treatments reach the people who need them with expert-led teams delivering contract medical, commercial + communications excellence for 40+ years.
Build and manage relationships with key stakeholders across health plans.
Design and implement referral pathways within health plan workflows to connect members.
Monitor referral trends and proactively engage case managers to increase appropriate referrals.
Ophelia is a healthcare startup that provides medication and clinical care through a telehealth platform to help individuals with OUD. They are a team of physicians, scientists, entrepreneurs, researchers and White House advisors, backed by technology and healthcare investors.
Collaborate with account teams to achieve sales and growth targets.
Sell Amwell’s core products and clinical programs within key accounts.
Support implementation and ensure optimal performance of Clinical Partner Programs.
Amwell is transforming healthcare through technology, improving lives globally. They provide innovative solutions to address healthcare challenges, offering a technology-enabled care platform that supports various clinical programs.
Spearhead strategy, operations, and contracting for VIVIO’s Medical Specialty Drug Carve-Out.
Proactively identifying, fostering, and overseeing partnerships, optimizing mutual value.
Collaborate across various functional areas of the partnerships as well as within VIVIO.
VIVIO Health, a Public Benefit Corporation, is revolutionizing pharmacy benefits management through data and technology. Since 2016, our evidence-based approach has delivered superior health outcomes while reducing costs for self-insured employers and health plans.
Help shape how AI understands and supports real-world clinical reasoning, patient interactions, and healthcare delivery.
Review, label, evaluate, and refine AI systems designed to support healthcare professionals and improve patient outcomes.
Work alongside AI researchers as part of an expert network matched to AI initiatives.
Aptura AI is building the next generation of clinically grounded AI. They partner directly with physicians to ensure these systems are safe, accurate, and aligned with real-world clinical reasoning.
Review admissions and service requests for medical necessity and reimbursement compliance.
Provide case management and consultation for complex cases and coordinate discharge planning.
Oversee compliance with federally mandated and third-party payer utilization management rules.
UAB St. Vincent's is a trusted healthcare provider serving Alabama for over 125 years, offering comprehensive care across five hospitals and clinics. The organization employs over 4,800 people and fosters a collaborative culture rooted in compassion, service, respect, and teamwork.
Provide high-quality preventative, acute, and chronic care in a fully remote, virtual setting
Manage a dedicated panel of patients as their primary care physician
Refer patients to specialists or acute care services when clinically indicated
K Health partners with top-rated hospital systems to expand access to primary care using their AI-powered virtual care engine. Founded in 2016 and headquartered in New York City, they're backed by nearly $400 million from leading investors.
Conduct consultations via phone, video, or asynchronously based on state telemedicine regulations
Provide care using our custom EMR: evaluating patient records, diagnosing, and prescribing medication, and making lifestyle recommendations
Follow best practices and company specific policies for diagnosis, treatment, and documentation
RPM (Roman Pennsylvania Medical, P.C.) is a telehealth practice providing high-quality, patient-centric care as part of Ro's provider network. Ro is a direct-to-patient healthcare company connecting providers with patients for mental health, women’s health, and other healthcare needs.
Reviewing cases, educating patients on appropriate care.
Managing health care costs for the dependents of our Nation’s Active Duty and eligible retirees.
Working remotely Monday through Friday, 8 hours per day.
Spectrum Healthcare Resources (SHR) delivers systems and processes designed to meet the unique needs of Military and VA Health Systems. They provide physician and clinical staffing and management services to United States Military Treatment Facilities and VA clinics.
Provide high-quality preventative, acute, and chronic care in a fully-remote, virtual setting
Elevate remote care by providing compassionate and meaningful patient encounters
Manage a dedicated panel of patients as their primary care physician
K Health partners with the nation's top-rated hospital systems to expand access to primary care. They are headquartered in New York City, and backed by nearly $400 million from leading investors.
Evaluates certification requests by reviewing the group specific requirements.
Triage the call to determine if a Utilization Review Nurse is needed to complete the call.
Cottingham & Butler sells a promise to help their clients through life’s toughest moments. Their culture is guided by the theme of “better every day” constantly pushing themselves to be better than yesterday.