Contact patient and complete a thorough assessment, including physical, psychosocial, emotional, spiritual, environmental, and financial needs.
Develop treatment plan for standard and catastrophic cases in collaboration with the patient, caregivers or family, community resources and multi-disciplinary healthcare providers that include obtainable short- and long-term goals.
Advocate for the patient by facilitating the delivery of quality patient care, and by assisting in reducing overall costs; provide patient/family with emotional support and guidance.
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. They serve employers, health plans, and health systems with data-driven solutions that reduce costs while actually improving health outcomes and have a mission to empower people to lead healthier lives.
Managing the care of patient panel by leveraging experience and knowledge.
Establishing relationships with patients and families to provide support.
Serving as an advocate and community liaison for patients.
Evergreen Nephrology partners with nephrologists to transform kidney care through a value-based, person-centered, holistic, and comprehensive approach. We are committed to improving patient outcomes and quality of life by delaying disease progression and shifting care to the home.
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.
Manage communications between patients and doctors and associated documentation.
Collaborate with Customer Service to troubleshoot patient requests pertaining to physician requirements.
Provide clinical feedback in response to patient inquiries involving medication, lab, side effects.
Hone is an online medical clinic transforming healthcare and enhancing longevity. They use scientific advancements to empower individuals to take control of their health. Hone is a remote-first employer with a focus on people and a culture that values collaboration and joy.
Conduct targeted patient outreach to close care gaps and ensure timely care transitions.
Deliver high-touch engagement for high-risk patients to prevent readmissions through follow-up.
Collaborate with Practices to support interventions such as Transitional Care Management.
Aledade empowers independent primary care practices, helping them deliver better care and thrive in value-based care. Founded in 2014, they are the largest network of independent primary care in the country with a collaborative, inclusive, and remote-first culture.
Enhance the quality of member management and maximize satisfaction.
Assist in navigating the health care system as a collaborative health partner.
Promote wellness, problem-solve, and assist members in realization of their personal health-care related goals.
Guidehealth is a data-powered, performance-driven healthcare company dedicated to operational excellence. Driven by empathy and powered by AI and predictive analytics, Guidehealth leverages remotely-embedded Healthguides™ and a centralized Managed Service Organization to build stronger connections with patients and providers.
Perform monthly CCM touchpoints for assigned patient panels.
Evaluate changes in condition using licensed clinical judgment.
Escalate urgent issues based on defined triage pathways.
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 by delaying disease progression, shifting care to the home, and accelerating kidney transplants.
Deliver coordinated, patient-centered virtual Care Management by telephone or video that improves members' health outcomes.
Help members navigate complex medical conditions, treatment pathways, benefits, and the healthcare system in general.
Assist throughout acute healthcare episodes, such as hospitalizations and rehabilitation stays, providing coordinated Case Management to support the member and their family.
Included Health is a healthcare company that delivers integrated virtual care and navigation, aiming to raise the standard of healthcare for everyone. They break down barriers to provide high-quality care for every person, offering care guidance, advocacy, and access to personalized virtual and in-person care.
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.
Engage with patients and healthcare providers via phone and virtually.
Serve as a clinical resource for therapy adherence, addressing inquiries related to medication and side effects.
Act as a liaison between healthcare professionals and patients, navigating therapy access challenges.
EVERSANA provides commercialization services to the life sciences industry with a global team of more than 7,000 employees. They serve over 650 clients, ranging from innovative biotech start-ups to established pharmaceutical companies, to bring therapies to market and support patients.
Provide exceptional care, disease management and health education to patients
Support goal setting for individual patients asynchronously to help them better manage their chronic conditions
Create personalized action plans with guidelines to reduce or eliminate unwanted behaviors
Salvo is focused on chronic gut health and metabolic conditions from IBS to obesity, assigning patients a care team and providing app-based care seven days a week. Salvo is backed by leading health care investors from innovators; they offer a culture that drives constant innovation and is marked by relentless curiosity and a sense of empathy.
Coordinates and oversees all direct and indirect patient services provided by clinical organization personnel.
Provides guidance and counseling to coordinators and Clinical Supervisors to assist them in continually improving all aspects of home health care services.
Assists the Executive Director in the preparation and administration of the organization's budget.
Mission Healthcare, located in seven states, is the largest home health and hospice company in the western United States. They provide services that meet the needs of patients and families across the healthcare continuum and believe their people deserve care delivered with Compassion, Accountability, Respect, Excellence and Service.
Assesses symptoms via telephone to identify acuity and appropriately disposition caller/patient using best-practice updated protocols.
Documents call criteria in eMR within a timely manner, promoting second-level triage and virtual care visits when appropriate.
Provides health information to customers via UnityPoint Health’s approved resources, maintaining strict confidentiality.
UnityPoint Health is committed to its team members and has been recognized as a Top 150 Place to Work in Healthcare by Becker's Healthcare. With a collective goal to champion a culture of belonging where everyone feels valued and respected, they honor the ways people are unique and embrace what brings us together.
Serve as the remote support hub for Nurse Practitioners (NPs) practicing in Skilled Nursing Facilities (SNFs).
Improve NP efficiency and patient outcomes by owning clinical, data, and communication tasks.
Perform clinical triage, educate families, manage program data, and coordinate complex care.
HealthDrive delivers on-site dentistry, optometry, podiatry, audiology, behavioral health, and primary care services to residents in long-term care, skilled nursing, and assisted living facilities. They connect patients in need of vital healthcare to doctors committed to dignity and excellence.
Coordinate and implement medical case management to facilitate case closure.
Assess appropriate utilization of medical treatment and services.
Review medical records and assess data to ensure appropriate case management process.
Berkley Medical Management Solutions (BMMS) provides managed-care service for W.R. Berkley Corporation, focusing on injured worker’s return to work. BMMS was started in 2014 and combines clinical practices, return-to-work strategies, and software for workers’ compensation cases.
Work independently to make clinical decisions on routine patient care matters.
Provide patient-focused care and guidance on the phone or online.
Monitor your own performance with dashboard metrics and look for ways to improve.
Carenet Healthcare Services provides telehealth and virtual care clinical triage assessments, health education and other services to diverse populations of patients and health plan members. They are known to connect nurses and clinical staff with consumers as a trusted, behind-the-scenes partner for health plans and health systems.
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.
Handle inbound calls from patients and caregivers, providing compassionate and informed triage.
Assist with finding appropriate providers, community resources, and care solutions and coordinate priority virtual appointments.
Research information online and in Privia’s internal knowledge databases to make the most appropriate triage and care advice decisions.
Privia Health is a technology-driven, national physician enablement company that collaborates with medical groups, health plans, and health systems. They optimize physician practices, improve patient experiences, and reward doctors. Their platform is led by top industry talent and consists of scalable operations.
Review daily inpatient and observation admissions across the system.
Evaluate physician documentation and patient data to determine admission status.
Collaborate with interdisciplinary teams for authorizations and medical necessity reviews.
Jobgether is a company that uses AI to help candidates get hired. They use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements.