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.
Provide telephonic case management and utilization review for assigned consumers.
Develop, implement, and monitor individualized care plans to ensure quality and cost-effective outcomes.
Collaborate with healthcare providers, payors, and internal teams to coordinate care.
Cottingham & Butler helps clients through life's toughest moments by providing insurance and benefits solutions. The company fosters a culture of continuous improvement, seeking to hire, train, and grow the best professionals in the industry.
Collaborate with primary care providers to coordinate care for patients with multiple chronic conditions, ensuring high-quality care through telephonic and in-person outreach.
Conduct transitional care management including post-discharge follow-up and provide education on lifestyle coaching and dietary improvements.
Operate independently to achieve goals, attend regular care team meetings, and perform other duties as assigned.
Privia Health is a technology-driven national physician enablement company that collaborates with medical groups and health systems to optimize practices and improve patient care. The company is led by top industry talent and focuses on scalable operations and cloud-based technology to reduce healthcare costs and improve outcomes.
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.
Review Home Health prior authorization requests for medical necessity using CMS regulations and Clover clinical guidelines.
Perform initial and concurrent clinical reviews, ensuring appropriate care in the least restrictive setting.
Collaborate with providers and internal teams to support timely decision-making and positive member outcomes.
Clover Health is a healthcare company that uses data and technology to provide affordable, high-quality insurance plans for seniors. The company fosters a remote-first culture with a diverse and mission-driven team focused on improving member outcomes.
Provide telephonic triage assessments and health education using nursing protocols and algorithms.
Utilize critical thinking and communication skills to manage diverse patient populations.
Work a flexible schedule that includes evenings and weekend shifts from your home office.
Carenet Health provides telephonic clinical assessments, health education, and utilization management services to patients and members. They are a growing organization with a collaborative national team of Registered Nurses, offering work-from-home options and a supportive culture.
Provide comprehensive case management services including assessing client needs, developing care plans, coordinating services, and monitoring progress.
Collaborate with healthcare professionals, insurance companies, and stakeholders to ensure seamless care coordination and favorable outcomes.
Maintain accurate documentation, educate clients and families on self-management, and stay current with industry best practices.
MVP Health Care is a not-for-profit health plan provider focused on creating a healthier future through innovation and equity. For over 40 years, they have served New York and Vermont communities with high-quality health plans and have been recognized as a Best Place to Work.
Provides visionary leadership and strategic direction for care coordination and service delivery teams.
Drives transformational initiatives to scale operations, enhance quality, and improve patient outcomes.
Uses data analytics and key performance indicators to monitor program effectiveness and guide evidence-based decision-making.
WellSky is a technology company that provides software, analytics, and services for intelligent, coordinated care across health and community care. The company fosters a culture of independent thinking, collaboration, and innovation, with a focus on improving outcomes and lowering costs.
Perform utilization review including precertification and concurrent reviews using medical necessity criteria.
Collaborate with medical directors and providers on complex cases and integrate AI tools into workflow.
Initiate referrals to disease management programs and participate in quality improvement initiatives.
Guidehealth is a data-powered healthcare company that uses AI and predictive analytics to improve healthcare affordability and patient outcomes. It is a physician-led organization with a culture of accountability, learning, innovation, and empathy.
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.
Provide telephonic and video-based follow-up care for post-hospital discharge patients, focusing on medication reconciliation, symptom screening, and care coordination.
Collaborate with nursing team and coordinate across settings to keep patients connected and improve health outcomes.
Meet individual performance targets while contributing to team population health goals in a digital-first environment.
Galileo is a team-based medical practice working to improve the quality and affordability of health care for all. Operating across 50 states, Galileo offers high-touch, data-driven, multi-specialty, longitudinal care to diverse and complex patients. Founded by Dr. Tom X. Lee, the team of leading innovators from healthcare and technology is committed to transforming healthcare through inclusive and collaborative culture.
Provide exceptional care, disease management and health education to patients.
Support goal setting for individual patients to help them better manage chronic conditions.
Coordinate with other clinical team members to provide an exceptional patient experience.
Salvo Health is a tech-enabled healthcare company focused on chronic gut and metabolic conditions. Backed by leading health investors, it offers a multidisciplinary care team approach with board-certified specialists and digital tools.
Assess, plan, implement, and coordinate comprehensive care plans to meet individual health needs and ensure cost-effective healthcare delivery.
Serve as a liaison facilitating collaboration among patients, families, physicians, and providers to promote quality of care.
Provide specialized education on disease-specific conditions and remain current with medical trends and procedures.
Arkansas Blue Cross and Blue Shield is a health insurance company providing healthcare coverage and services. They are consistently ranked as a top workplace in Central Arkansas with an inclusive culture and average employee tenure of 10 years.
Lead, coach, and develop a team of Engagement Specialists through regular feedback and performance management.
Conduct compassionate outreach to patients, explain services, and guide them through onboarding with accurate EHR documentation.
Oversee daily operations, optimize PRM workflows, and collaborate with clinical teams for seamless care transitions.
The employer is a mission-driven healthcare organization dedicated to improving access to behavioral health support for individuals navigating complex medical journeys. It is a fast-growing, startup-like company with a collaborative culture focused on continuous learning and innovation.
Develop and coordinate individualized treatment plans and discharge services for patients.
Perform medical record reviews to assess admission appropriateness and ensure compliance with standards.
Support denials management and appeals for insurance claims to ensure quality care.
Northwestern Medicine is a healthcare system focused on patient-first care. We offer a supportive workplace with competitive benefits and a culture of growth.
Deliver comprehensive, coordinated health services remotely using telehealth technology.
Assess patients, provide education, manage chronic conditions, and coordinate care plans with multidisciplinary teams.
Dedicate 50% of time to direct patient care and 50% to care transformation, including mentoring and leading simulations.
CommonSpirit Health is one of the nation's largest nonprofit Catholic healthcare organizations, providing integrated health services. With over 157,000 employees and 45,000 nurses, the organization operates more than 2,300 clinics and 137 hospitals across 24 states.
Provide telephonic case management to proactively drive return to work.
Perform utilization review and coordinate care with providers and adjusters.
Evaluate treatment plans and partner with adjusters to achieve optimal outcomes.
AmTrust Financial Services is a fast-growing commercial insurance company providing comprehensive telephonic case management. They foster a diverse and inclusive culture with a focus on attracting and retaining the best talent.
Provide clinical assessment and nursing triage to diverse patients across the health continuum.
Assist in directing patients to the most appropriate level of care via telephonic health information.
Work in collaboration with Telehealth providers for virtual care visits and follow-up calls.
We bring hospitals and healers together in the pursuit of clinical effectiveness. With a portfolio of over 8 million patients, 7500 providers, and 400 healthcare facilities, we are a leader in clinical practice management with a culture of belonging and empowerment.
Manage UM nurse team performance, SLAs, and quality improvement.
Handle escalated UM cases and provider disputes 25% of time.
Partner with clients, medical directors, and IDTs to ensure consistent decision-making.
IntusCare builds an end-to-end ecosystem for Programs of All-Inclusive Care for the Elderly (PACE) to improve care, financial performance, and compliance. As a healthcare technology company, we empower teams to improve outcomes for dual-eligible seniors.
Conduct telehealth visits for patients in the House Calls program, managing chronic conditions and geriatric syndromes.
Perform care management assessments, coordinate care with providers, and document accurately in the EMR.
Ensure compliance with clinical protocols and participate in interdisciplinary case reviews.
Essen Health Care is the largest privately held, multispecialty medical group in New York, providing high-quality, compassionate care to underserved residents. Founded in 1999, the network has grown to 50+ locations with 500+ providers, fostering a team-oriented culture focused on population health.