Review patient charts and documentation against defined coverage criteria.
Work with internal AI software that enables review productivity and apply structured processes to determine documentation sufficiency.
Produce clear, standardized written summaries of review outcomes and meet daily throughput and quality targets.
Verse Medical is building the modern software infrastructure to make hospital-quality care accessible everywhere. They're a well-funded Series C company, backed by notable investors, on a mission to heal a fragmented system by connecting providers, payors, and patients.
Performs utilization review to determine medical necessity criteria compliance and facilitates resolution of escalated cases.
Collaborates with clients and physician reviewers, ensuring adherence to all HIPAA, state, federal, and regulatory standards like URAC & NCQA.
Utilizes various computer systems to manage cases, engages in provider communication, and participates in quality management programs while prioritizing independent work.
WNS, part of Capgemini, is an AI-powered leader in intelligent operations and transformation, serving over 700 clients across industries like Healthcare and Financial Services. It is a large global company with over 66,000 employees, combining deep domain expertise with AI platforms to create lasting business value.
Conducts phone screens and clinical evaluations for patients and families seeking admission.
Provides education, orientation, and motivation to engage patients and families in care.
Produces robust, timely documentation to support seamless transitions into treatment, leveraging AI note-writing tools.
InStride Health delivers specialty anxiety and OCD care for kids, teens, young adults, and families. They combine research-backed clinical care and innovative technology to eliminate the major problems with care today. The company is focused on expanding access to insurance-based care to improve outcomes.
Provide independent medical documentation review and functional capacity analysis to support RA determinations under the Rehabilitation Act of 1973 and aligned with EEOC.
No patient care, no medical exams, record based review only (paper file review).
Ability to clearly communicate medical findings in written form for non-clinical review.
AdNet/AccountNet, Inc. is an 8(a), WOSB, and WBE-owned management consulting firm founded in 1990. We blend the best people with the ongoing demands of the workplace by providing high-quality staffing and executive search services.
Review medically complex claims, pre-authorization requests, appeals, and fraud/abuse referrals.
Assess payment determinations using clinical information and established guidelines.
Evaluate medical necessity, appropriateness, and reasonableness for coverage and reimbursement.
Broadway Ventures delivers tailored solutions that drive operational success, sustainability, and growth for government and private sector clients. As an 8(a), HUBZone, and Service-Disabled Veteran-Owned Small Business (SDVOSB), they empower clients with expert program management, cutting-edge technology, and innovative consulting solutions.
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.
Provide compassionate, evidence-based care to clients across the country.
Treat a variety of clients, including couples and children.
Help clients achieve measurable progress using modern clinical technology.
Thriveworks is a mental health care company founded by clinicians. They have 340+ locations with a nationwide hybrid care model, serving over 175,000 clients annually through more than 1.7 million sessions and growing.
Lead program operations including onboarding, scheduling, communication, and documentation to meet CARF standards.
Track and support residents' supervision hours, training progress, and licensure milestones while coordinating with clinical, HR, and compliance teams.
Maintain a small clinical therapy caseload, providing direct client care and assisting with client coordination such as referrals.
Backpack Health delivers behavioral health care with a focus on youth and families. It is a collaborative, mission-driven team that offers a supportive culture and values diversity and inclusion.
Provide excellent quality clinical care that exemplifies Rivia Mind’s culture.
Service and maintain a weekly average standard of 31 patients.
Conduct comprehensive intake evaluations and develop patient-centered treatment plans.
Rivia Mind provides mental health care, believing it begins with a human connection. They serve individuals across multiple states through virtual and hybrid appointments and cultivate a collegial culture rooted in shared values and reciprocal support.
Provide health assessments and treatment solutions via telephone, video, or chat functions.
Receive inbound phone calls from patients seeking answers to various medical conditions.
Stay up to date with current health trends and recommendations.
PWNHealth is a national clinician network improving early disease detection and prevention using advanced diagnostics and telehealth, serving all 50 states and Puerto Rico. They are a mission-driven company with a positive culture, backed by leading growth equity firms Spectrum Equity and the Blue Venture Fund (BVF).
Drive quality, safety, and compliance through systems by identifying issues and implementing process improvements.
Execute order management and EMR workflows by reviewing and approving new orders and supporting clinical escalations.
Manage end-of-episode processes, hospital holds, and monitor patient status and quality compliance through dashboards and alerts.
They are building an AI-native physical care platform to fix US healthcare, starting with home health. The company has assembled a team of AI experts from leading firms and paired them with healthcare veterans to operate at the speed of an AI company.
Evaluates member health metrics and professional resources to inform UM/CM initiatives and programs.
Refers members and providers to G.E.H.A resources and programs, as indicated, maximizing their health plan benefits.
Monitors and evaluates program effectiveness, tracks relevant metrics, and reports outcomes.
Government Employees Health Association (G.E.H.A) is a nonprofit member association providing health and dental benefits to millions of federal employees and retirees since 1937. G.E.H.A is headquartered in Lee's Summit, Missouri, offering hybrid and work-from-home options for many roles.
Responsible for the review and processing of claims within the claims transactional system, according to plan benefits and contractual reimbursement terms.
Follows established policies and procedures to pay, pend for additional information, or deny claims.
Accountable to meet and maintain established department production and quality standards.
Evry Health is on a mission to bring humanity to health insurance by expanding benefits, increasing access and transparency, and featuring a personalized, human approach. Evry Health is the major medical division of Globe Life (NYSE:GL) with more than 3,000 corporate employees and 15,000 agents.
Manage day-to-day credentialing and re-credentialing workflows for Tia’s provider network.
Support medical licensing workflows for MDs, DOs, NPs, PAs, and RNs across multiple states, including tracking requirements, deadlines and renewals.
Track onboarding progress and help ensure providers are licensed, credentialed, enrolled, and compliant before go-live.
Tia is building a new model for women’s healthcare, one that treats women as whole people. They are a Series D, venture-backed company trusted by more than 120,000 women across four markets, building a culture of excellence in people, process, and product.
Provide independent medical documentation review and functional capacity analysis to support RA determinations.
Determinations under the Rehabilitation Act of 1973 and aligned with EEOC.
No patient care, no medical exams, record based review only (paper file review).
AdNet/AccountNet, Inc. is an 8(a), WOSB, and WBE-owned management consulting firm founded in 1990. We blend the best people with the ongoing demands of the workplace by providing high-quality staffing and executive search services.
Works with field staff and Manager, Clinical Services (MCS) to appropriately schedule clinicians for cases in assigned areas of responsibility.
Communicates appropriately regarding changes in schedule or service delivery.
Demonstrates the ability to be efficient and productive by organizing job duties and responsibilities.
CommonSpirit Health at Home is a full-service health care organization that believes the best place for someone to get better is in their own home. As a faith-based organization, we are committed to finding new ways to improve the health of our patients and the health of the communities we serve.
Conduct telehealth counseling sessions using our technology platform.
Create comprehensive patient assessments and assist in treatment planning.
Ensure documentation complies with clinical and state regulations.
Mood Health is a mission-driven mental health group practice dedicated to transforming the mental health care experience. We aim to make effective treatments accessible to everyone and we pride ourselves on a vibrant workplace culture.
Primarily responsible for making outbound calls to healthcare providers.
Accepting inbound calls from healthcare providers.
Answer questions about participation requirements, registration, assessment completion and scoring results.
WNS, part of Capgemini, is an Agentic AI-powered leader in intelligent operations and transformation, serving more than 700 clients across 10 industries. With over 66,000 employees, we combine scale, expertise and execution to create meaningful, measurable impact.
Passionate about patient care and committed to clinical excellence.
Fully licensed and credentialed in CA, including a Ph.D. or Psy.D.
Experienced with caring for adult and/or child and adolescent populations.
LifeStance Health is dedicated to providing comprehensive mental healthcare services. They foster a collegial work environment with newly designed offices and full administrative support, focusing on incorporating the latest digital technology.
Conduct objective medical case reviews for the Department of Veterans Affairs using standardized assessment criteria.
Evaluate the timeliness and appropriateness of care to identify quality improvement opportunities and assess medical decision-making.
Provide expert medical opinions by analyzing complex clinical scenarios from an impartial, evidence-based perspective.
Broadway Ventures is a service-disabled veteran-owned small business that provides expert program management, technology, and consulting solutions to government and private sector clients. With a focus on integrity and collaboration, the firm is a certified 8(a) and HUBZone contractor dedicated to operational success and growth.