Pulling, sorting, and analyzing data to determine member eligibility for the Population Health management Program.
Coordinating and providing care that is timely, effective, equitable, safe, and member-centric while following HMO processes.
Managing case assignments which includes outreach, documentation, monitoring for case progression, and case closure.
Guidehealth is a data-powered healthcare company dedicated to operational excellence. They aim to make healthcare affordable, improve patient health, and restore fulfillment in practicing medicine. Guidehealth is a growing and innovative organization and employees are expected to adapt to evolving business needs.
Provide patient-focused telehealth clinical triage assessments and health education via phone, video, and chat.
Work independently to make clinical decisions, assess needs, and direct patients to appropriate care levels while documenting interactions.
Monitor performance metrics, participate in coaching sessions, and communicate with clients and team members.
Carenet Health is a behind-the-scenes partner for over 250 of the nation's premier health plans and health systems, providing telehealth and virtual care clinical triage assessments and health education. Named one of America's fastest-growing private companies by Inc. Magazine for eight consecutive years, the company is integrity-driven and focused on compassionate, evidence-based care.
Review and validate all assigned OASIS assessments for accuracy, completeness, and internal consistency.
Code and sequence diagnoses per ICD-10 and CMS guidelines to ensure optimal reimbursement.
Provide clear, actionable feedback to field clinicians with a focus on education and process improvement.
Adaptive Home Health builds a higher-acuity, patient-centered home health model across Michigan. The company operates in a tech-forward environment with strong operational support.
Coordinate and oversee the MDS process for all residents, ensuring accuracy, completeness, and regulatory compliance.
Collaborate with interdisciplinary teams to maximize reimbursement through accurate documentation and chart review.
Maintain knowledge of Medicare, Medicaid, and regulatory requirements, and educate staff on documentation best practices.
Limitlessli specializes in recruiting, hiring, and managing high-caliber remote staff for dynamic and growing healthcare facilities. We leverage our global network to connect clients with qualified professionals and offer tailored services to meet unique business needs.
Answer calls and resolve questions, routing to appropriate departments.
Complete documentation in EMR and marketing systems, including initial prescreening.
Schedule new and returning patients and complete follow-up duties.
Pyramid Healthcare provides addiction treatment, mental health recovery, and eating disorder treatment. They focus on client-centered care and offer supportive environments that help patients overcome life’s challenges.
Conduct telephonic case management and thorough assessments of patients' physical, psychosocial, and financial needs.
Develop and monitor treatment plans in collaboration with patients, caregivers, and multidisciplinary teams.
Negotiate cost management strategies and maintain detailed documentation while meeting productivity and quality standards.
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 and health plans with data-driven solutions and are on a mission to empower people to lead healthier lives.
Deliver virtual, patient-centered care with empathy and clinical excellence.
Triage patient concerns using evidence-based protocols and sound clinical judgment.
Coordinate laboratory follow-ups, referrals, and diagnostic services across the care team.
MyLaurel is a healthcare organization delivering virtual acute care support to vulnerable patients. They are a collaborative, high-performing team focused on transforming healthcare delivery.
Serve as the main point of contact for patients and families transitioning from or seeking post-acute services.
Make clinical level-of-care determinations using discussions, medical records, and other clinical data.
Provide patient education on home health, hospice, palliative care, Medicare coverage, and billing.
Gentiva is a national leader in hospice, palliative, and home health care, providing compassionate care to patients in their homes. With nearly 600 locations and thousands of clinicians across 38 states, they offer a collaborative environment where inspiring achievements are recognized.
Provide clinical review and correspondence for utilization management, including medical necessity reviews and member communications.
Collaborate with Medical Directors to ensure evidence-based decisions that meet NCQA and CMS standards.
Maintain productivity and quality while working 100% remotely in a fast-paced environment.
Cohere Health’s clinical intelligence platform and agentic AI-powered solutions connect health plans’ strategic goals and providers’ needs, optimizing the speed, cost, and quality of care. With over 250 employees, the company fosters a supportive, growth-oriented environment and has been named to the Inc. 5000 list and a Top 5 LinkedIn Startup.
Manage daily hospital census of engaged members, reviewing alerts and updating information in the EMR system.
Communicate with hospital/discharge planners, notifying patients of WellBe's awareness of their hospitalization, and track admissions.
Engage in telephonic conversations with patients and families, explaining the WellBe program and aiming to schedule post-discharge appointments.
WellBe is pioneering a new way of healthcare that is revolutionizing the industry. They have a patient-focused environment that ensures patients can live a fulfilling life, offering growth and development opportunities across expanding markets and celebrating success globally.
Monitor a specific group of patients and support them in achieving short and long term health goals.
Coordinate with providers to ensure patients' needs are met through remote monitoring technology.
Manage patient onboarding, device setup, data management, and quality assurance for remote monitoring programs.
Optima Medical is an Arizona-based medical group consisting of 30 locations and over 130 medical providers, caring for more than 200,000 patients statewide. Their mission is to help communities 'Live Better, Live Longer' through personalized healthcare, with a focus on preventing leading causes of death.
Completes telephonic outreach to engage and schedule patients for health assessments.
Maintains call targets and metrics to ensure program success and volume goals are met.
Provides patient education and coordinates appointments and resources as needed.
Lumeris empowers value-based care, making healthcare safer, more affordable and personalized for providers, patients, and payers. The company is an EEO/AA employer with a focus on growth and employee engagement in a fast-paced environment.
Support payer audits and medical record reviews, ensuring timely submission of documentation.
Manage medical review requests and appeals associated with CMS contractors and regulatory agencies.
Review clinical documentation using audit checklists and partner with teams to gather required records.
VitalCaring is a provider of home health and hospice services founded in 2021. They are a growing company focused on quality and compliance, with a mission to deliver exceptional patient care.
Coordinate care and collaborate with multiple disciplinary team members to improve the quality of care and clinical outcomes.
Conduct thorough assessments to determine unmet needs and develop individualized care plans.
Promote quality cost-effective outcomes with the goal of improved care coordination.
Dignity Health Medical Foundation works hand-in-hand with physicians and providers throughout California to provide comprehensive health care services. They strive to create purposeful work settings where staff can provide great care, while advancing in knowledge and experience through challenging work assignments and stimulating relationships.
Serve as the primary point of contact for physicians, clinics, and healthcare stakeholders, ensuring consistent communication and trusted relationships.
Support healthcare providers in navigating patient assistance programs, including enrollment, reimbursement, and therapy access processes.
Manage and complete all required documentation such as special authorizations, prescription renewals, and enrollment forms with accuracy and timeliness.
Jobgether is an AI-powered job matching platform that connects candidates with hiring companies. They use technology to ensure fair and efficient recruitment processes, and foster inclusive employee programs.
Conduct high-volume telehealth intake appointments to assess patient goals and explain service offerings.
Manage scheduling, lab orders, prescription logistics, and EHR maintenance for a fully remote care team.
Drive patient engagement through strategic outreach, coaching, and issue resolution to ensure high satisfaction.
Bold is the leading healthy aging platform, offering personalized, evidence-based exercise programs for Medicare members that help prevent falls, reduce pain, and increase activity. The company is backed by leading investors including Andreessen Horowitz and Khosla Ventures and has a patient-centered care team.
Perform concurrent and retrospective reviews on all facility and appropriate home health services.
Monitor level and quality of care and proactively manage acutely and chronically ill patients.
Act as liaison to Plan Medical Director and coordinate interdisciplinary approach.
Curana Health is a national leader in value-based care for senior living communities and skilled nursing facilities. Founded in 2021, they serve 200,000+ seniors in 1,500+ communities across 32 states with a team of over 1,000 clinicians.
Answer emergency and non-emergency calls, dispatch responses, and monitor medical alerts with compassion.
Provide exceptional customer support using scripted and non-scripted responses in high-pressure situations.
Record call details accurately, troubleshoot alarms, and recommend preventative healthcare services.
VRI connects people with care through non-emergency medical transportation and personal home care services. They serve the underserved to improve access and outcomes, with a focus on compassionate support.
Manage the member's clinical experience from request through desired outcome, including account activation and medical history drafting.
Coordinate video or phone consults with specialists and schedule monitors in advance, troubleshooting issues as needed.
Conduct ongoing follow-up post-consult and facilitate local recommendations, communicating with primary care physicians or specialists.
Transcarent is a health and care platform that combines medical, pharmacy, and point solutions with a generative AI-powered experience for health consumers. With over 1,700 employer and health plan clients serving 21 million Members, they foster a culture of People First, Care, Resilience, Results, and Humble and Human.
Serve as a key point of contact for patients, coordinating scheduling, insurance verification, and follow-up activities.
Manage inbound and outbound calls, maintain accurate EMR records, and ensure HIPAA compliance.
Communicate with patients, providers, and insurance companies to deliver high-quality, patient-centered care.
SnappyCX provides customer support and administrative services to various industries. They operate with a remote team and emphasize a fast-paced, healthcare-focused environment.