Maintain ongoing caseload of individuals through the utilization of evidence based approaches to promote engagement and achievement of health goals
Use relationship-based strategies to support members with social support navigation, understanding that many may have lived personal experiences causing them to be initially hesitant or distrusting of the health care system
Conducts periodic telephonic and SMS outreach to ensure timely follow-up to members
Pair Team is an innovative, mission-driven company reimagining how Medicaid and Medicare serves the most underserved populations. As a tech-enabled medical group, they deliver whole-person care - clinical, behavioral, and social - by partnering with organizations deeply connected to the communities they serve.
Oversee the provider performance and escalations team.
Conduct audits and quality assurance reviews to promote quality of care.
Work closely with cross-functional partners to strengthen and improve quality of care systemically through innovation.
Spring Health is on a mission to revolutionize mental healthcare by removing every barrier that prevents people from getting the help they need, when they need it. They partner with over 450 companies and provide care for 10 million people and their valuation has reached $3.3 billion.
Manages client denials and concerns through analytic review of clinical documentation.
Delivers final determination based on skillsets and partnerships with Humana parties.
Investigates and resolves member and practitioner issues via phone or face to face to support quality goals.
Humana Inc. is committed to putting health first for teammates, customers, and the company. Through Humana insurance services and CenterWell healthcare services, they strive to make it easier for millions to achieve their best health, delivering needed care and service.
Develop deep understanding of the clinical data needs and data usability requirements across Devoted Health Plans and Devoted Medical.
Analyze clinical data availability across geographical areas to develop insights about data gaps, the reasons data is not available, and opportunities to obtain data.
Implement technical integrations with Health Information Exchanges (HIEs), Labs, Electronic Health Record (EHR) systems, and other sources of clinical data and ensure quality of data received.
Devoted Health is on a mission to dramatically improve the health and well-being of older Americans by caring for every person like family. Founded in 2017, they've grown fast and now serve members across the United States.
Investigate and resolve care complaints and grievances about providers
Develop and monitor Quality Improvement initiatives and activities that drive care delivery outcomes
Assist in maintaining Spring Health Provider Policy Guide to maintain compliance with all legal, regulatory, and payer requirements
Spring Health is on a mission to revolutionize mental healthcare by removing every barrier that prevents people from getting the help they need, when they need it. They partner with over 450 companies and provide care for 10 million people.
Monitor and optimize network adequacy, ensuring geographic and clinical coverage meets member demand.
Define and track key performance drivers, designing reporting frameworks for real-time visibility.
Drive cross-functional strategy to bridge network gaps, partnering with Clinical, Product, and Operations teams.
Lyra Health is the leading provider of mental health solutions for employers, supporting more than 20 million people globally. They have delivered 13 million sessions of mental health care and are known for their AI-powered platform and research-backed approach, which improves access, clinical effectiveness, and cost efficiency.
Lead day-to-day communication for assigned health plan clients
Manage requests and deliverables with tight tracking
Build client reports, dashboards, and status updates
Urrly uses AI to review every application against the same clear requirements for the role. This means every candidate is evaluated on job-related factors like skills, certifications, and experience—not on personal attributes such as gender, race, age, or background.
Manage a portfolio of sponsor and client accounts, leading recurring calls, business reviews, and ad-hoc engagements.
Drive responsiveness and service levels for sponsor requests, communicating with accuracy and awareness of business risks.
Translate sponsor goals into cross-functional delivery plans.
Jobgether is a company that uses an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. They identify the top-fitting candidates, and this shortlist is then shared directly with the hiring company.
Document solutions in reusable articles to support future issue resolution
Experian is a global data and technology company, powering opportunities for people and businesses around the world. A FTSE 100 Index company listed on the London Stock Exchange (EXPN), they have a team of 23,300 people across 32 countries and are known for investing in their people and new advanced technologies.
Oversee daily practice operations, ensuring consistent delivery of administrative and operational functions.
Manage administrative logistics including scheduling, coverage, resource allocation, and routine practice communications.
Monitor and track staff licensing deadlines, renewals, and required documentation.
FOLX Health is the leading health and wellness platform for LGBTQIA+ care, providing end-to-end services, both virtually and in person, across the spectrum of community needs. They foster a culture of reliability, transparency, access, and agency, trusting their team to get their jobs done.
Own the design, execution, and ongoing improvement of Pair Team’s in-person care delivery operations
Build scalable workflows that support field-based visits, including care package delivery, success visits, and care plan check-ins
Serve as the operational point of contact for in-person care delivery, supporting managers and leaders with guidance and structure rather than individual-level coordination
Pair Team is an innovative, mission-driven company reimagining how Medicaid and Medicare serve underserved populations. As a tech-enabled medical group, they deliver whole-person care by partnering with organizations deeply connected to the communities they serve. They empower clinicians and care teams to provide compassionate, high-impact care.
Maintain oversight over a specified panel of members by performing ongoing assessments.
Create comprehensive care plans addressing members' needs and conducting regular follow-ups.
Ensure achievement of targeted goals related to patient outcomes and care plan realization.
Jobgether is a company that uses an AI-powered matching process to ensure applications are reviewed quickly, objectively, and fairly against the role's core requirements. Their system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company.
Assists in coordinating patient care with medical staff by reviewing and maintaining provider schedules.
Ensures patient-specific needs are met by arranging interpretation services as needed.
Prepares patients for virtual appointments by ensuring the patient has what is needed for their appointment.
Ascend Healthcare provides fully integrated, quality psychiatric and behavioral health services. They foster a professional, collaborative, and rewarding workplace culture, dedicated to making a profound impact on diverse communities through exceptional patient care.
Manage prior authorizations and related administrative paperwork.
Input patient information, medical records (CPT, ICD-10, HCPCS), and billing data into EMR/EHR systems.
Assist with processing insurance claims, verifying patient insurance information, and handling billing inquiries, concerns, and documentation.
Wing is redefining the future of work for companies worldwide. They aim to be a one-stop shop for companies looking to build world-class teams and place their operations on autopilot.
Gather, validate, and prepare data from multiple sources.
Identify missing or inconsistent fields and partner with Operations to resolve issues.
Zócalo Health is the first tech-driven provider built specifically for Latinos, by Latinos, developing a new approach to care designed around shared and lived experiences. Founded in 2021, they are backed by leading healthcare and social impact investors.
Serves as a lead to Clinical Business Operations Representatives and facilitates the prompt resolution of highly complex problems related to pre and post care that arise in daily clinical operations.
Performs administrative and receptionist functions, to include answering incoming calls, efficient management of patients, and the acquisition of necessary patient care and records.
Assists patients in a courteous, efficient, and professional manner and ensures adherence to divisional and departmental service standards.
The University of Miami and UHealth have become one of the nation’s top research universities and academic medical centers. With more than 17,000 faculty and staff, the University strives for excellence, and is driven by a powerful mission to transform and impact the lives of its students, patients, members of the community, and people across the globe.
Answer a high volume of inbound calls and chats from members, providers, and vendors.
Own the member's journey, including researching and resolving complex cases.
Explain all available benefits and help members understand their healthcare options.
Included Health delivers integrated virtual care and navigation. They break down barriers to provide high-quality care for every person, offering care guidance, advocacy, and access to personalized virtual and in-person care. They are an equal opportunity employer.
Support clinical staff by gathering data to complete the medical necessity review process.
Create and send letters to providers and/or members to communicate information.
Collaborate with care management teams and stakeholders to provide optimal service.
Wellmark is a mutual insurance company owned by policy holders across Iowa and South Dakota, and they’ve built their reputation on over 80 years’ worth of trust. They are motivated by the well-being of their members, putting them first and committing to sustainability and innovation.
Coordinate comprehensive onboarding for new therapists and nurse practitioners.
Serve as the main point of contact for provider questions, concerns, and technical issues.
Monitor provider satisfaction and engagement, identifying opportunities for improvement.
Seven Starling is revolutionizing women's behavioral health through our clinically-validated virtual care platform. As a venture-backed, rapidly scaling startup at the forefront of maternal healthcare innovation, they have developed a groundbreaking clinical model that combines specialized therapy, peer support, and medication management to effectively treat perinatal mood disorders.
Serve as a key account manager for assigned vendors.
Manage vendor utilization including workflows for coordinating services.
Track, analyze, and report on vendor performance and opportunities for improvement.
Jobgether uses an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. They identify the top-fitting candidates, and this shortlist is then shared directly with the hiring company.