Own first-level reviews of pre-certification requests for medical appropriateness and necessity.
Drive post-service reviews and manage the appeals process for non-certified services.
Coordinate smooth discharges and redirect care in-network to keep patients on track.
Personify Health created the first personalized health platform, bringing health plan administration, wellbeing solutions, and care navigation together in one place. Their team serves employers, health plans, and health systems with a mission to empower people to lead healthier lives.
Provide remote patient advocacy for Medicare members, untangling health situations and addressing Social Determinants of Health.
Use LPN/LVN clinical background to build trust with patients via phone or video calls.
Design care plans factoring in everyday barriers like food access and transportation.
Solace is a healthcare advocacy company that helps patients navigate the complex U.S. healthcare system. Founded in 2022, it is a Series C startup with a lean, mission-driven team backed by major investors.
Take triaged cases and build urgent execution plans using resource directories and independent research.
Work the plan, call patients to update them, and document every interaction accurately for seamless 24/7 handoffs.
Push through obstacles like busy signals, denials, and system hurdles until the problem is solved, typically within 2–3 days.
Mira Mace is a venture-backed company on a mission to help people navigate a complicated healthcare system with clarity and confidence. They pair people-centered navigation with technology, and their advocates cut through insurance denials, medication costs, and paperwork so patients get what they need without fighting alone.
Perform monthly clinical check-ins and structured symptom assessments for assigned patient panels.
Collaborate with providers to escalate urgent issues and reinforce care plans within LPN scope.
Document all patient interactions in EHR and CCM platform while ensuring compliance with billing and quality metrics.
Evergreen Nephrology partners with nephrologists to transform kidney care through a value-based, person-centered, holistic approach. The company is committed to improving patient outcomes and quality of life, but specific employee size is not mentioned.
Plan, direct, and evaluate potential patients through assigned referral system.
Establish consistent communication with admitting hospitals to ensure a best-in-class admission process.
Work with Outreach Managers to assess patient needs in accordance with the Pre-Screening Evaluation Form.
NeuroPsychiatric Hospitals is a national leader in behavioral healthcare, specializing in patients with acute psychiatric and complex medical needs. With locations in Indiana, Michigan, Texas, and Arizona, we are expanding access to our unique model of care across the United States.
Communicate with Skilled Nursing Facilities to secure bed offers for patient placements from acute care.
Manage the entire referral-to-bed-offer process, coordinating with case managers and handling patient discharge issues.
Build relationships with SNF accounts to optimize bed availability and document bed flows and discharge calendars.
Southcoast Health is a not-for-profit health system with multiple hospitals and clinics in Southeastern Massachusetts and Rhode Island. They have been voted 'Best Place to Work' for seven consecutive years and foster a culture of well-being and inclusion.
You will serve as a critical liaison between patients, providers, care teams, and community resources to ensure continuity of care.
You will create and promote adherence to treatment plans developed by healthcare providers.
You will assess patients' unmet health and social needs and connect them to relevant community resources.
Point C is a national third-party administrator that delivers customized self-funded benefit programs. We are a mission-driven company focused on innovative cost containment strategies and driving down plan costs.
Provide clinical education, focused interventions, and care transition support for members with low-acuity needs.
Conduct in-person and virtual clinical exams, medication reconciliation, and chart reviews.
Triage referrals and collaborate with care team to ensure timely follow-up and handoffs.
Cityblock Health is a tech-driven provider for communities with complex needs, offering personalized primary care, behavioral health, and social services. Founded in 2017 and backed by Alphabet, the company has a diverse, inclusive culture and is growing rapidly.
Set daily direction for your UM team, establishing priorities and reinforcing expectations.
Coach reviewers on criteria application, guiding consistent use of medical-necessity criteria.
Monitor workflow health daily, tracking intake volume and turnaround risk.
Personify Health created the first and only personalized health platform, bringing health plan administration, holistic wellbeing solutions, and comprehensive care navigation together. The team is on a mission to empower people to lead healthier lives.
Serve as a primary contact for medication inquiries, triaging calls and portal messages with empathy and urgency.
Facilitate prior authorizations and coordinate follow-up appointments to ensure continuity of care.
Document all interactions using SBAR standards and educate patients on refill policies and adherence.
Mindpath Health is redefining how mental health care is delivered, operating in more than 100 locations across six states with in-person and telehealth services. The team is deeply committed to compassionate, collaborative care and values diversity and inclusion.
Assess and coordinate care for members, ensuring continuity and person-centered service plans.
Manage a caseload of 20-30 calls per day, including crisis calls, and lead interdisciplinary care teams.
Coach and mentor less experienced Care Managers to support team development.
Integrated Resources, Inc. is a workforce solutions company that delivers strategic talent management services. Founded in 1996, the company has grown steadily and focuses on matching qualified professionals with employers, building long-term partnerships based on performance and integrity.
Handle real-time staffing coordination and same-day scheduling changes for seamless care delivery.
Serve as the first point of contact for urgent client and family needs with empathy and professionalism.
Execute operational tasks like check-ins and inbound communications adhering to company policies.
Honor is a leader in aging care innovation, providing technology and services to empower older adults to live independently. With 100,000 Care Pros delivering 50 million hours of care annually through its Home Instead brand, Honor prioritizes compassionate, tech-backed care.
Provide on-demand telephone-based care management services through a 24/7 Nurse Advice Line.
Assess symptoms and concerns of callers to determine urgency and type of care needed.
Coordinate care across the healthcare delivery system and record patient data in medical record systems.
Privia Health is a technology-driven, national physician enablement company that collaborates with medical groups, health plans, and health systems to optimize physician practices and improve patient experiences. The company is led by top industry talent and physician leadership, and focuses on reducing healthcare costs and improving outcomes.
Conduct telephonic clinical assessments and health education using nursing process and protocols.
Utilize critical thinking to triage, make care recommendations, and document patient interactions.
Work a schedule including evenings and weekends, with full-time flexibility and remote setup.
Carenet Health provides clinical services and health education to patients through innovative telephonic channels. They are a growing organization with a collaborative team of registered nurses across the United States.
Provide telehealth clinical triage assessments and health education to diverse populations via phone, video, and chat.
Utilize critical thinking and clinical skills to assess patient needs, direct to appropriate care, and influence health decisions.
Document interactions and monitor performance metrics while participating in coaching sessions to improve quality.
Carenet Health provides telehealth and virtual care clinical triage assessments, health education, and services to patients and health plan members. The company has been named one of America's fastest-growing private companies by Inc. Magazine for eight consecutive years and fosters a culture of compassion, innovation, and work-life balance.
Provides comprehensive remote patient support and care coordination to optimize health outcomes in a virtual environment.
Collaborates with physicians and healthcare team members to assess patient status and develop personalized care plans.
Monitors patient progress, educates on disease processes, and advocates for patient needs to ensure high-quality care.
St. Joseph's Hospital and Medical Center is a 571-bed not-for-profit hospital in Phoenix, Arizona, offering quaternary care, medical education, and research. It is a nationally recognized center with over 125 years of history, consistently named an outstanding place to work.
Perform prospective, concurrent, and retrospective utilization reviews for behavioral health services across multiple care settings.
Assess medical necessity and coordinate care with providers, members, and internal teams to ensure appropriate access and treatment.
Support discharge planning, benefit utilization, and regulatory compliance while improving overall care quality.
This company provides high-quality behavioral health coordination and utilization management services to improve member outcomes. They foster a supportive, collaborative environment focused on professional growth and clinical excellence.
Manage a portfolio of clients, providing clinical support, education, advocacy, and care coordination throughout their healthcare journey.
Conduct clinical intakes, collaborate with internal teams, and ensure smooth transitions across care delivery.
Communicate clearly and compassionately with clients, caregivers, providers, and internal partners.
Private Health Management guides patients and families through serious medical care, acting as an independent advocate to orchestrate the best treatment and support. The company is a mission-driven organization with a team of experts that provides compassionate, high-quality care coordination.
Provide clinical care and education asynchronously to members
Assist clinicians in reviewing prescriptions, ordering labs, and checking state PDMP
Collaborate with referral specialists and support quality assurance activities
We are FOLX Health, the leading health and wellness platform for LGBTQIA+ care, offering end-to-end services virtually and in person. Our culture is built on reliability, transparency, access, and agency, trusting our team to get the job done.
Learn Solace's proprietary system, tools, and technology while providing your unique experience in every interaction.
Build strong, trusting relationships with patients, using listening and empathy as the foundation for every interaction.
Identify and prioritize patients’ needs and build out a care plan that holistically addresses social determinants of health.
Solace helps patients navigate healthcare complexity by pairing them with expert advocates. They are a Series C startup founded in 2022, with a lean, mission-driven team growing quickly, and a culture that is intense and not for coasting.