Reaches out to members telephonically to assist with referrals, authorizations, HHC, DME needs, medication refills, make provider appointments and follow ups, etc.
Creates cases, tasks, and completes assessments in Case Management module for all Hospital and SNF discharges
Works as a team with the Case Manager to engage and manage a panel of SNP members
Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve.
You will be responsible for using your assessment and communication skills to engage with patients in need of clinical support to determine and prioritize their needs.
Conduct timely telephonic clinical outreach to identified patients.
Collaborate with PCPs, NPs, and other members of the healthcare team to coordinate care for patients and actively help keep them stable at home.
Vytalize Health is building a market leader in value-based healthcare. They are a rapidly growing organization that embraces the power of AI and encourages innovative, responsible use of emerging technologies in their work.
Responsible for coordination of services for members, emphasizing education/self-management and quality care. \n- Assesses member needs, reviews service options, develops and implements care plans, and coordinates resources. \n- Manages a caseload of moderate-high risk members with complex medical/behavioral/psychosocial needs.
Capital Blue Cross is committed to improving the health and well-being of our members and the communities in which they live. They offer flexibility, prioritize health and well-being, and encourage employees to volunteer in their community.
Provide case management to members including medical, social, psychological, physical, and spiritual needs.
Develop, implement, and monitor the care plan in conjunction with the PCP, caregivers, and other team members.
Help meet the member's needs.
Elderplan and HomeFirst are Medicare and Medicaid managed care health plans that are expanding services in response to patients' needs. At MJHS, they are a supportive community committed to excellence, respect, and providing high-quality, personalized health care services.
Assess member needs in physical health, mental health, and social supports.
Oversee the development of client care plans and goal settings.
Connect clients to social services, advocate for their needs, and ensure documentation.
Vynca is dedicated to transforming care for individuals with complex needs, fostering a close-knit community committed to caring for each other and the people they serve. Guided by core values like excellence and compassion, Vynca empowers employees to make a profound difference in providing comprehensive care for more quality days at home.
Play an active role in member registration and enrollment, including organizing community engagement and outbound outreach calls/texts.
Engage with a panel of assigned members to provide care navigation, appointment logistics, prescription drug support, lab support, referral coordination, care plan adherence support, and resource sharing.
Serve as the primary relationship holder for members with behavioral health needs; provide consistent outreach, follow-up, and re-engagement support, including after ED/inpatient discharge when applicable.
Zócalo Health is a tech-enabled, community-oriented primary care organization serving people who have historically been underserved by the one-size-fits-all healthcare system. They combine local, community-based teams with virtual care and modern technology to deliver coordinated, whole-person care where members live and receive support.
Enhance the quality of member management and maximize satisfaction.
Assist in navigating the health care system as a collaborative health partner.
Promote wellness, problem-solve, and assist members in realization of their personal health-care related goals.
Guidehealth is a data-powered, performance-driven healthcare company dedicated to operational excellence. Driven by empathy and powered by AI and predictive analytics, Guidehealth leverages remotely-embedded Healthguides™ and a centralized Managed Service Organization to build stronger connections with patients and providers.
Identifying caregiver availability and staffing new cases efficiently.
Updating all relevant systems with caregiver availability and case details.
Assigning caregivers to cases and verbally reviewing all patient details, duties, special requirements, travel time, and expectations.
SnappyCX is a dynamic and innovative company at the forefront of the BPO industry providing talent outsourcing. They redefine the benchmarks for excellence in talent-centric solutions.
Deliver compassionate, personalized service to support each member’s unique therapy journey.
Manage new and ongoing therapy cases, ensuring accurate documentation and coordination.
Resolve inquiries quickly and accurately, using critical thinking to address complex issues.
VIVIO Health helps make data the basis for clinical decision-making. Their evidence-based, data-driven specialty drug management and cost control solution has improved healthcare outcomes and lowered costs for large, self-insured employers since 2016.
Facilitate collaboration with health plan care managers
Tuesday Health is a value-based palliative care provider group dedicated to transforming serious illness and end-of-life care. They deliver goal-centered care focused on alleviating physical symptoms and emotional stress for individuals and their caregivers.
Complete timely review of healthcare services using appropriate medical criteria to support determinations.
Document clinical findings and rationale clearly and accurately in accordance with federal/state regulations, URAC standards, and Guidehealth policies.
Communicate precertification and concurrent review decisions—verbally and in writing—to required parties within defined timeframes.
Guidehealth is a data-powered, performance-driven healthcare company dedicated to operational excellence. They aim to make great healthcare affordable, improve patient health, and restore fulfillment in practicing medicine for providers. Driven by empathy and powered by AI and predictive analytics, Guidehealth leverages Healthguides™ and a Managed Service Organization to build stronger connections with patients and providers.
Communicate and provide education to members and providers on insurance plan benefits and digital health solutions.
Employ active listening & motivational interviewing skills, and can handle difficult calls tactfully, professionally and document accordingly that can build patient trust and engagement.
Accurately track and document work on a variety of internal software tools and platforms.
Evry Health is on a mission to bring humanity to health insurance. They provide high-technology health plans that expand benefits, increase access and transparency, and feature a personalized, human approach. Evry Health is the major medical division of Globe Life (NYSE:GL), which has 16.8 million policies in force, and more than 3,000 corporate employees and 15,000 agents.
Provides non-clinical administrative support to Case Managers and Care Coordinators.
Obtains and manages medical documents, ensuring accurate record retrieval.
Prioritizes tasks based on expedited requests with attention to detail.
Spectrum Healthcare Resources (SHR) delivers systems and processes designed to meet the unique needs of Military and VA Health Systems. They provide physician and clinical staffing and management services to United States Military Treatment Facilities, VA clinics and other Federal Agencies.
Build trusting relationships with patients, families, and providers, addressing health questions and care needs.
Identify medical, behavioral, social, emotional, and financial needs to support whole‑person care.
Strengthen the connection between patients and healthcare providers by addressing barriers and facilitating communication.
Guidehealth is a data-powered, performance-driven healthcare company dedicated to operational excellence, with the goal to make great healthcare affordable, improve patient health, and restore fulfillment for providers. They leverage remotely-embedded Healthguides™ and a centralized Managed Service Organization to build stronger connections with patients and providers.
Engage and enroll eligible health plan members in supportive care services.
Educate members on Tuesday Health’s service offerings and support ongoing engagement.
Provide ongoing telephonic customer service to members and their caregivers.
Tuesday Health is a value-based palliative care provider group dedicated to transforming serious illness and end-of-life care. They deliver goal-centered care focused on alleviating physical symptoms and emotional stress for individuals and their caregivers and are shaping the future of community-based palliative care nationwide.
Handle high volume of incoming calls (80+ per week), serving as the primary contact.
Coordinate care, patient referrals , timely scheduling of initial and follow-up appointments.
Schedule, reschedule, and monitor care assignments across multiple care locations.
SnappyCX is connecting top talent with leading healthcare innovators to improve patient access and outcomes. They provide professionals with diverse clinical and non-clinical backgrounds the opportunity to do meaningful work from home.
Coordinating care and supporting Registered Nurses.
Ensuring clear communication and maintaining patient privacy standards.
Collaborating with medical professionals to improve patient outcomes.
Limitlessli specializes in recruiting, hiring, and managing high-caliber remote staff for dynamic and growing healthcare facilities. Leveraging their extensive global network, they connect clients with highly qualified professionals, offering tailored services to meet their clients' unique business needs.
Develop trusting relationships with patients, grounded in listening, respect, and clarity.
Assess the whole person — medical, social, and environmental factors — to pinpoint barriers and needs.
Create individualized care plans that integrate medical, social, and behavioral supports.
Baba makes navigating health, aging, and loneliness easier by pairing each patient with a real human advocate team that supports them between visits. Baba is backed by top tier investors and supports thousands of families across assisted living, nursing homes, and at-home settings.