Supervise, direct and evaluate a diverse group of health care professionals to assure effectiveness of care coordination activities.
Develop audit plans and tools for teams to ensure compliance with state contracts on performance metrics and to ensure member needs are met.
Interview, hires, mentors, evaluates, coaches and manage performance for a diverse care coordination team.
Humana Inc. is committed to putting health first for its teammates, customers, and company. Through Humana insurance services and CenterWell healthcare services, they aim to make it easier for the millions of people they serve to achieve their best health.
Working with a team of Intake Coordinators and Utilization Review Nurses to ensure quality and timely determinations.
Striving for continuous improvement and an excellent work-life balance to produce top-notch results.
Coordinating and providing care management that is timely, effective, efficient, equitable, safe, and member centered.
Guidehealth is a data-powered, performance-driven healthcare company dedicated to operational excellence. Our goal is to make great healthcare affordable, improve the health of patients, and restore the fulfillment of practicing medicine for providers.
Provides quality driven telephonic clinical assessments, health education, and utilization management services.
Provides assessments to individuals using telecommunications in accordance with computer-based algorithms, protocols, and guidelines.
Uses clinical knowledge to assess, disposition, make recommendations for care, provide education and health information.
Carenet Health values the expertise and dedication of their team members. They are committed to offering an appealing compensation package and creating an inclusive environment for all employees.
Work remotely to enhance member management and maximize cost effectiveness.
Collaborate with clients and members to promote wellness and assist in achieving health goals.
Collect data, conduct clinical reviews, and ensure documentation complies with regulations.
Guidehealth is a data-powered healthcare company dedicated to operational excellence. They aim to make healthcare affordable and improve patient health, employing remotely-embedded Healthguides™ and a Managed Service Organization to build stronger connections with patients and providers.
Conduct thorough assessments of patients' needs and develop treatment plans.
Monitor treatment effectiveness and adjust plans while documenting outcomes.
Advocate for patients to ensure quality care delivery and assist in cost reduction.
The company provides remote case management nursing services. The posting mentions an engaging company culture that values diversity and continuous learning.
Provide operational leadership and oversight for Privia Health’s telephonic triage and after-hours care coordination platform.
Responsible for data-driven performance management, workflow optimization, staff scheduling, and resource planning to support safe, scalable, and cost-effective service delivery.
Oversee Health Advisors and operational support staff, ensuring adherence to protocols, communication standards, and service-level expectations.
Privia Health is a technology-driven, national physician enablement company that collaborates with medical groups, health plans, and health systems to optimize physician practices, improve patient experiences, and reward doctors for delivering high-value care. The Privia Platform consists of scalable operations and end-to-end, cloud-based technology.
Conduct quality audits of inpatient clinical determinations to ensure alignment with clinical guidelines and quality standards
Analyze QA findings and translate insights into actionable recommendations for operational leaders and cross-functional partners
Provide coaching and feedback to improve clinical decision accuracy, guideline adherence, and overall team performance
Cohere Health delivers AI-powered solutions that streamline access to quality care by improving payer-provider collaboration, cost containment, and healthcare economics. They work with over 660,000 providers and are backed by leading investors such as Deerfield Management. The coherenauts who succeed there are empathetic teammates who are candid, kind, caring, and embody their core values and principles. Cohere is deeply invested in ensuring that they have a supportive, growth-oriented environment that works for everyone.
Reviews pre-admissions for correct classification and admission order.
Performs Utilization Review for each patient on their assigned daily census using established medical necessity guidelines.
Communicates with payers regarding authorization and medical necessity, utilizing excellent negotiating skills.
Oregon Health & Science University values a diverse and culturally competent workforce. They are an equal opportunity, affirmative action organization that does not discriminate against applicants.
Participate in provider case reviews to identify trends and deficits.
Coach providers and participate in client meetings to support expectations.
Contribute to workflow design, QA improvements, and risk management.
Amwell transforms healthcare with technology and people. They aim to provide convenient, affordable, and effective care, serving large healthcare organizations in the U.S. and worldwide.
Strengthening the connection between the patient and their primary care physician/medical practice staff, as well as improving the patient’s health and well-being.
Engaging patients and helping them navigate their care, solve their healthcare issues, and improves communication with their medical practice.
Assisting the patient in achieving better health outcomes by addressing their questions and concerns, connecting them with the medical practice.
Guidehealth is a data-powered, performance-driven healthcare company dedicated to operational excellence. Their goal is to make great healthcare affordable, improve the health of patients, and restore the fulfillment of practicing medicine for providers.
Coordinates home infusion services for compliance.
Organizes, plans, and evaluates agency services and programs.
Ensures effective delivery of services to maintain quality care.
BioMatrix is a nationwide, independently-owned infusion pharmacy with decades of experience supporting patients on specialty medication. Their compassionate care team helps patients navigate the often-challenging healthcare environment and treats their patients like family.
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.
Directly responsible for the provision of direct patient care within the assigned setting, supervising 2-3 associate therapist.
Directly responsible for the supervision, staffing and coordination of clinical employees within the program’s service lines.
Conducts ongoing chart reviews to ensure compliance with established standards.
Ascend Healthcare provides fully integrated, quality psychiatric and behavioral health services in a compassionate, convenient, and affordable manner. They deliver integrated psychiatric and behavioral health solutions with a commitment to equity, compassion, and operational excellence, fostering collaboration, a patient-first mindset, and career growth.
Provide timely, high-quality clinical recommendations grounded in evidence-based practice.
Effectively communicate assessment findings and provide advice to the in-center team.
Provide input into resident care plans in collaboration with the in-center team.
Summerset is the second largest retirement village operator in New Zealand, passionately dedicated to providing quality service to its clients. They are growing quickly, with 39+ villages, and proud of their dynamic work environment and diverse workforce.
Provide direct supervision, coaching, and performance oversight to clinical managers.
Serve as a primary operational liaison between clinical teams and health plan care management teams.
Oversee onboarding and training for care teams and clinical 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. They cultivate a dynamic and inclusive team environment.
Responsible for quality assurance, accuracy and overall integrity of the UAS-NY assessment data and visit documentation completed by core team nurses as well as, business partners’ nurses.
Performing assessment audits, identifying trends that require staff retraining, and implementing corrective action plans in collaboration with Clinical management staff.
Responsible for ongoing orientation, training and education of Assessment Nurses conducting UAS-NY assessments, and participate in establishing educational modules for staff orientation and re-training.
Elderplan and HomeFirst are Medicare and Medicaid managed care health plans that are expanding services in response to patients' and members' needs. MJHS is a supportive community committed to excellence, respect, and providing high-quality, personalized health care services.
Deliver patient centric health coaching that integrates medical needs with patient preferences.
Triage patient reported symptoms and side effects according to internal protocols, escalating to Providers when appropriate.
Provide comprehensive diabetes, hypertension, hyperlipidemia, and weight management care and education via chat, phone, and video.
9amHealth is a specialized cardiometabolic care provider, offering custom care plans, prescription medications, and expert guidance to help members live healthier. They are a San Diego, California-based company with a small, flexible team and are backed by 7Wire Ventures, Human Capital, Founders Fund, and Define Ventures.
Answer and triage after-hours calls across Ohio markets.
Conduct remote clinical assessments to determine patient and family needs.
Evaluate patient status changes and provide symptom management guidance.
Luminary Hospice is a mission-driven organization that empowers its team members to shape the culture and provide high-quality support to patients and families during their end-of-life journey. They are centered on caring for the whole person, providing expert medical care, pain management, and emotional and spiritual support to families and caregivers.
Coordinate patient enrollment, assist with device setup, and provide education on the purpose, benefits, and usage of remote monitoring technology.
Monitor patient data collected through remote monitoring devices and software platforms; analyze trends, identify abnormalities or significant changes in patient health status, and escalate issues to appropriate healthcare providers for intervention.
Develop strategies to engage and motivate patients to actively participate in remote monitoring programs; provide ongoing support, encouragement, and education to patients to promote adherence to monitoring protocols and healthy behaviors.
Optima Medical is an Arizona-based medical group consisting of 30 locations and over 130+ medical providers, who care for more than 200,000 patients statewide. Their mission is to improve the quality of life throughout Arizona by helping communities "Live Better, Live Longer" through personalized healthcare, with a focus on preventing the nation’s top leading causes of death.
Responsible for daily operations of direct reports while driving operational initiatives.
Leads clinical implementation efforts within an assigned team or partner for new technologies and workflows.
Drives change management and adoption of new tools and workflows at team level by partnering with training and peer leaders.
Twin Health empowers people to improve and prevent chronic metabolic diseases, like type 2 diabetes and obesity, with a new standard of care, applying AI Digital Twin technology exclusively toward metabolic health. The company has been recognized for its innovation and culture and is scaling rapidly across the U.S. and globally.