Analyze health plan reports and clinical data to identify members eligible for case management.
Conduct comprehensive telephonic and virtual assessments to evaluate medical, behavioral, and social needs.
Develop, implement, and monitor individualized care plans with measurable goals and interventions.
Duly Health and Care is a physician-led medical group offering a connected network of primary and specialty care, surgery centers, imaging, lab, and therapy services. They foster a collaborative culture centered on putting patients first and supporting team growth.
Manage care for high-risk members by identifying needs and coordinating clinical, community, and in-network resources.
Perform utilization management reviews, ensure quality oversight, and support accreditation readiness.
Collaborate with multidisciplinary teams to analyze member outcomes and drive continuous improvement.
They are a health plan focused on improving outcomes for high-risk members through care coordination and quality initiatives. Their team values collaboration, clinical excellence, and mission-driven work to enhance community health.
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.
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.
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.
Coordinate and oversee collaborative patient care under physician direction, guiding patients through intake, diagnosis, treatment, and discharge.
Communicate with patients, physicians, and agencies to manage referrals, treatment plans, and pre-authorizations for desired clinical and financial outcomes.
Perform patient intake and discharge activities, including vital signs, room turnover, and documentation in accordance with hospital policy.
Virginia Mason Franciscan Health provides exceptional healthcare services, building on a legacy of compassionate care and innovation dating back to 1891. The organization employs a dedicated team across 10 hospitals and nearly 300 care sites, committed to healing the whole person and fostering a collaborative purpose.
Conduct detailed assessments and coordinate individualized care plans with healthcare teams.
Educate patients and families on disease processes, treatment options, and self-care strategies.
Advocate for patients' needs within the healthcare system, ensuring timely access to services.
Empowers individuals facing health challenges by providing compassionate, expert-guided care advocacy services. Dedicated to ensuring personalized support and seamless care coordination.
Review medical history with patients in preparation for prescriber review.
Provide patient counseling on medication use, safety, and side effects.
Collaborate with the Customer Experience team and medical network to coordinate care.
Remedy (formerly Thirty Madison) revolutionizes healthcare accessibility by providing remote care and support. The company is building a diverse and inclusive workplace as part of a larger organization.
Review medical records to develop concise clinical reviews supporting authorization and reimbursement.
Facilitate communication with payors to ensure appropriate utilization management decisions.
Collaborate with interdisciplinary team to prevent denials and optimize patient care.
West Virginia University Health System is West Virginia’s largest health system, providing comprehensive healthcare services. With over 35,000 employees and 25 hospitals, it is the state's largest employer and offers a collaborative, patient-centered culture.
Strategically assess, plan, and facilitate comprehensive care across the continuum for high-risk patients.
Collaborate with physicians, nursing, insurers, and post-acute providers to ensure timely transitions.
Work remotely from California, using provided equipment, with potential weekend/holiday coverage.
Dignity Health Management Services provides integrated managed care administrative and clinical services to medical groups, hospitals, and health plans. It is part of CommonSpirit Health, one of the largest nonprofit health systems in the US, with a focus on coordinated patient care and community health.
Authorizes and reviews utilization of mental health and substance abuse services in inpatient and outpatient settings.
Provides telephone triage, crisis intervention, and discharge planning while collaborating with clinical teams and providers.
Analyzes utilization data, participates in quality improvement projects, and advocates for patient treatment needs.
Magellan Health is a managed care organization focused on behavioral health and substance abuse services. They are a large employer with a culture centered on caring, professional growth, and employee wellbeing.
Coordinate and oversee patient care requests, ensuring timely and compassionate responses.
Serve as the central point of contact throughout the patient journey.
Maintain accurate electronic medical records and coordinate medical testing and follow-up care.
This company provides patient-centered healthcare coordination, connecting patients with physicians and specialists. They are a mission-driven organization that values collaboration, professional growth, and a supportive, inclusive workplace.
Coordinate comprehensive, person-centered care for clients with complex needs, partnering with healthcare providers and social services.
Assess member needs across physical health, mental health, social supports, and more, and oversee development of care plans.
Utilize evidence-based practices like Motivational Interviewing and Trauma-Informed Care to empower clients and promote wellness.
Vynca provides comprehensive care for individuals with complex needs, with a mission to enable more quality days at home. They describe themselves as a close-knit community guided by core values of Excellence, Compassion, Curiosity, and Integrity.
Conduct comprehensive psychiatric evaluations, diagnose mental health conditions, and develop individualized treatment plans.
Prescribe and manage psychiatric medications, provide ongoing follow-up care, and educate patients and families.
Collaborate with primary care providers and behavioral health team members to ensure integrated, patient-centered care and complete clinical documentation.
Optima Medical is an Arizona-based medical group providing personalized healthcare across Arizona and Nevada, focusing on prevention and full-spectrum services. With 34 locations and over 130 medical providers, they care for more than 200,000 patients in a mission-driven, collaborative environment.
Provide individualized clinical education, treatment-support services, and care coordination for patients in remote patient nutrition support and adherence programs.
Conduct structured outreach, identify barriers to treatment adherence, and develop practical strategies within program scope.
Document patient interactions, escalate clinical concerns per protocols, and collaborate with cross-functional teams.
PRO-spectus is a supportive, dedicated, and teamwork-driven company focused on improving the lives of patients they support. They have a culture that celebrates personal and professional accomplishments with humility and compassion.
Provide short-term, telephonic care management to high-risk patients in the 30 days after hospital discharge, focusing on preventing avoidable readmissions.
Conduct comprehensive assessments, develop individualized care plans, educate patients and caregivers, and coordinate with interdisciplinary teams and community resources.
Serve as a patient advocate, helping navigate complex care journeys while working in a remote, metrics-driven environment.
Our partner is a healthcare organization that provides transitions of care support for high-risk patients post-hospital discharge. They operate in a collaborative, technology-enabled environment focused on measurable outcomes and exceptional patient experiences, and they are hiring for this role through Jobgether, an AI-powered job matching platform.
Review and evaluate electronic medical records of emergency department admissions to screen for medical necessity using InterQual or MCG criteria.
Apply evidence-based clinical guidelines to assess and ensure proper utilization of healthcare resources.
Enter clinical review information into the system for transmission to insurance companies for authorization.
Netsmart provides advanced healthcare technology solutions for post-acute and human services clients, enabling better care through a comprehensive platform. We are a vision-driven team passionate about innovation, and we have been recognized as one of the best companies to work for.
Review medically complex claims, pre-authorization requests, appeals, and fraud and abuse referrals.
Assess payment determinations using clinical information and established guidelines.
Evaluate medical necessity, appropriateness, and reasonableness for coverage and reimbursement.
Broadway Ventures transforms challenges into opportunities with expert program management, cutting-edge technology, and innovative consulting solutions. As an 8(a), HUBZone, and Service-Disabled Veteran-Owned Small Business, we empower clients with tailored solutions, operating with integrity and collaboration.
Collaborate with care teams, maintain documentation in EHR systems, and deliver care via telehealth
Peregrine Health partners with community health organizations to expand access to behavioral health care. Their team of therapists, psychiatric nurse practitioners, and psychiatrists provide virtual care to underserved communities across the country.
Coordinate patient onboarding, device setup, and education on remote monitoring technology.
Monitor patient data, analyze trends, and escalate health changes to providers.
Collaborate with healthcare professionals to optimize care and ensure documentation accuracy.
Optima Medical is an Arizona-based medical group providing personalized healthcare with a focus on preventing leading causes of death. With 30 locations and over 130 providers serving 200,000 patients, they offer a supportive and positive work environment.