Performs pre-admission, admission, and continued stay reviews using approved medical necessity criteria.
Coordinates patient care and communicates with physicians, patients, caregivers, and third-party payers.
Manages patient progression through the healthcare system and proactively works with payers to secure certification and minimize denials.
Ochsner Health is a leading not-for-profit healthcare provider in the Gulf South, with 46 hospitals and 370+ care centers. It employs more than 38,000 team members and has been recognized as a top workplace and the No. 1 hospital in Louisiana.
Assess member needs across physical health, mental health, SUD, oral health, and social supports.
Develop and oversee client care plans, set SMART goals, and evaluate progress.
Coordinate with healthcare providers, connect clients to community services, and advocate on their behalf.
Vynca is a healthcare company dedicated to transforming care for individuals with complex needs, focusing on providing comprehensive care for more quality days at home. They are a close-knit community committed to core values of Excellence, Compassion, Curiosity, and Integrity, fostering an inclusive workplace.
Coordinates utilization review and prior authorization requests, ensuring accurate entry into the UM platform.
Provides customer service to providers and members, confirming benefits and answering authorization questions.
Facilitates communication between reviewers, hospitals, and physicians to ensure timely decisions.
University of Utah Health Plans is a patient-focused organization that enhances health through patient care, research, and education. It is part of a nationally ranked academic medical center with five hospitals and eleven clinics, fostering a culture of collaboration and excellence.
Apply utilization criteria to monitor appropriateness of admissions and continued stay reviews.
Communicate with third-party payers for initial and concurrent clinical review.
Prepare appeals on denied cases when appropriate.
Northpoint Recovery Holdings is a leading behavioral healthcare provider offering evidence-based treatment for adults with substance use and co-occurring disorders. Operating under an in-network commercial insurance model, the company has grown to seventeen facilities across the Western US and is guided by core values of humility, heart, inspiration, and conviction.
Provide assessment, diagnosis, and evidence-based counseling to individuals, families, and groups in a virtual/remote setting.
Develop behavioral health change plans and protocols, and provide patient education and skill training.
Perform case management, risk management documentation, and participate in quality improvement initiatives.
Presbyterian Healthcare Services is a locally owned, not-for-profit healthcare system with nine hospitals, a statewide health plan, and a growing multi-specialty medical group. Founded in 1908, it is New Mexico's largest private employer with over 14,000 employees, including 1,200 providers and 4,000 nurses, focused on improving community health.
Oversee system-level utilization management activities across the organization.
Ensure compliance with medical necessity criteria such as InterQual and Milliman.
Manage professional staff and review processes to optimize patient care.
Piedmont Healthcare is a healthcare system providing comprehensive medical services. It is a large organization focused on utilization management and quality care.
Lead a care team of Therapists and Behavioral Health Support Specialists to implement programs and deliver outcomes.
Empower members to improve their health through personalized case management targeting specific needs.
Analyze team performance and data to identify gaps and create improvement plans.
CareMind Washington is a behavioral health program management company that leads care teams to implement programs and deliver outcomes to health plan partners. The company emphasizes a hands-on approach, empowering teams to meet members with personalized care.
Manage end-to-end credentialing and payer enrollment for behavioral health providers and facilities.
Serve as subject matter expert on credentialing requirements, ensuring timely and compliant files.
Coordinate with HR, Talent Acquisition, and leadership to facilitate provider onboarding and resolve issues.
We are a leading provider of immediate-access behavioral health crisis care. We are physician-led and data-driven, with over 15 years of crisis care expertise, recognized as a national best practice.
Provide psychiatric evaluations, medication management, and ongoing care for Medicaid patients.
Enjoy full flexibility with your own hours, caseload, and preferred referrals.
Work remotely with administrative support and a robust referral network.
Third Space Therapy expands Medicaid-covered behavioral healthcare by combining private-practice independence with group support. They handle administrative tasks like billing and credentialing, allowing clinicians to focus on care.
Manage standard onboarding workflows for physical therapist enrollment across contracted payers and partner networks.
Review provider credentials, prepare application packets, and maintain accurate database records for compliant credentialing.
Communicate with insurance carriers and internal teams to ensure timely enrollment and resolve routine barriers.
Luna is revolutionizing the delivery of physical therapy by providing in-home care through a digital platform. As a start-up with supportive leadership, they offer opportunities for growth alongside a dedicated team.
Provide real-time support to clients during live virtual group sessions, reinforcing engagement and safety.
Document client participation and behavior, communicating concerns to the clinical team promptly.
Support care coordination and discharge planning to ensure continuity across levels of care.
Guidelight Health is a cutting-edge behavioral healthcare company dedicated to transforming lives through high-quality PHP and IOP services. As a newly launched organization, they are building a team of passionate professionals to reshape mental health care.
Provide professional and timely service to internal and external customers regarding benefit administration.
Resolve benefit service issues with internal staff and outside vendors.
Perform monthly reconciliation of Carrier invoices to report to customers.
OneSource Virtual (OSV) works exclusively with Workday customers to automate payroll, taxes, earned wage access, accounts payable, and benefits. With over 1,500 customers and 92% retention, OSV offers a values-based culture and professional development.
Provide evidence-based interventions via the Collaborative Care Model to individuals with mild to moderate symptoms.
Screen patients for behavioral health and substance use disorders and monitor treatment outcomes.
Coordinate care with primary care providers, psychiatric consultants, and care teams.
Concert Health is a national behavioral health medical group that integrates the Collaborative Care model into existing health care practices. They offer a remote work environment with a focus on work-life balance and a diverse, inclusive culture.
Perform medical reviews and utilization management to determine medical necessity for services and appeals.
Evaluate medical records and document decisions using clinical guidelines and protocol sets.
Educate members, providers, and staff on coverage determinations, medical terminology, and coding procedures.
Palmetto GBA is a healthcare administrator and one of the nation's largest medical claims processors. As part of BlueCross BlueShield of South Carolina, we've served clients for 70+ years and offer training and tuition assistance.
Provide 100% remote outpatient psychiatric care to lower-to-moderate acuity populations.
Manage standard sessions including 60-minute intakes and 30-minute follow-ups with full operational support.
Maintain clinical autonomy over schedule and patient population without pressure to increase volume.
Talkiatry is a clinician-led virtual psychiatry practice that combines the stability of a hospital practice with clinical autonomy for its providers. The company supports a collaborative culture with over 800 psychiatrists and PMHNPs and more than 300 therapists practicing across 32 languages.
Deliver individual and family therapy through secure telehealth platforms.
Develop individualized, trauma-informed treatment plans based on client needs.
Collaborate with an interdisciplinary care team including therapists, psychiatrists, and care coordinators.
The company provides accessible, high-quality mental health care to children, adolescents, and young adults via telehealth. It fosters a collaborative and flexible remote culture, supporting clinicians with professional development and interdisciplinary teamwork.
Provide outpatient mental health services through a fully remote telehealth program.
Work a Monday-Friday schedule with no weekends and flexible shift options between 9am and 8pm EST.
Deliver compassionate care to patients across the lifespan as part of a supportive, technology-driven team.
Brave Health is a community health-centered organization that expands access to mental health care by bringing treatment directly to patients through technology. They serve Medicaid and Medicare populations with a diverse team committed to making care accessible and affordable.
Engages members proactively and reactively to build trust and drive benefit and program engagement through motivational interviewing.
Develops individualized care plans based on comprehensive clinical, psychosocial, and SDOH assessments, coordinating resources across the care continuum.
Educates members and providers on benefits, digital health solutions, and self-management strategies while supporting utilization review and documentation.
Evry Health is a digital-first health plan focused on delivering comprehensive, member-centered care coordination for its fully insured commercial population. The company operates as a fully remote team with headquarters in Dallas, Texas, emphasizing a technology-forward and collaborative culture.
Identify members meeting outreach criteria using internal data and systems.
Conduct telephone and in-person outreach to coordinate appointments and address care barriers.
Connect members with community resources and support Medicaid eligibility and care integration.
Jobgether is an AI-powered job matching platform that connects candidates with hiring companies. They focus on efficient, objective application review and data privacy compliance.
Provide outpatient mental health services via telehealth, including assessments and treatment planning.
Work collaboratively with clients to achieve their goals, using a strengths-based approach.
Maintain accurate documentation and ensure HIPAA-compliant telehealth sessions.
Brave Health is a community health-centered organization dedicated to expanding access to compassionate, high-quality mental health care through technology. They aim to close the gap in Medicaid acceptance, serving a diverse population with a remote team.