Perform retrospective medical chart reviews to pinpoint areas for improvement.
Interpret performance data to uncover learning opportunities.
Lead diagnosis documentation education for clinical audiences.
Aledade empowers independent primary care practices. Founded in 2014, they are the largest network of independent primary care in the country, focusing on value-based care and a collaborative, inclusive, remote-first culture.
Provide strategic management oversight in designing, implementing, directing, and monitoring the Alliance’s Risk Adjustment Department functions.
Direct the Risk Adjustment Department, act as a subject matter expert, and provide executive-level advice and guidance on coding and risk adjustment methodologies and overall business operations.
Direct, manage, and supervise Risk Adjustment Department staff
Central California Alliance for Health is a regional non-profit health plan. They are committed to providing accessible, quality health care guided by local innovation, with over 500 dedicated employees and a culture that is respectful, diverse, professional and fun.
Review and audit clinical documentation for accuracy, timeliness, and regulatory compliance.
Ensure documentation meets Medicare Conditions of Participation, state regulations, and accreditation standards.
Lead and support Quality Assurance and Performance Improvement initiatives, tracking key clinical and operational indicators.
They are fixing US healthcare by building an AI-native physical care platform, starting with home health. The company is automating administrative work with AI to create a fundamentally different cost structure than incumbents, enabling them to serve more patients.
Audits clinical documentation and coding for inpatients, emphasizing mortality reviews to identify improvement opportunities and ensure compliance with guidelines.
Collaborates with clinical teams and medical staff as an expert educator to develop strategic plans and teaching tools that improve quality metrics and outcomes.
Manages advanced project work including Risk Adjustment and Quality Abstraction, while partnering with departments like IT and Analytics to design new workflow solutions.
Northwestern Medicine is a leader in the healthcare industry focused on a patient-first approach to cultivate a positive workplace. The organization provides competitive benefits like tuition reimbursement, loan forgiveness, and 401(k) matching to take care of its employees as part of a large health system.
Review clinical documentation and treatment trajectory to ensure care meets medical necessity standards.
Synthesize clinical documentation, medical record information, and outcomes data to make recommendations on next steps in care.
Partner cross-functionally to support high-quality, clinically appropriate care across the network.
Rula is dedicated to treating the whole person and aims to create a world where mental health is no longer stigmatized. They are a remote-first company committed to providing quality, evidence-based, and compassionate care, empowering individuals to take charge of their mental health.
Supervise day-to-day operations of assigned Utilization Management staff.
Provide full people management for assigned Utilization Management teams, including hiring and performance management.
Drive team performance against key metrics, including engagement, productivity, and quality scores.
Personify Health has created a personalized health platform, bringing health plan administration, wellbeing solutions, and care navigation together. Their data-driven solutions aim to reduce costs while improving health outcomes, empowering people to lead healthier lives.
Evaluate and present audit results and educational instruction to physicians, coders, and staff.
Review clinical documentation to ensure adherence to billing guidelines and internal coding policies.
Provide instruction on documentation standards and correct use of CPT‑4 and ICD‑10 codes.
Pediatrix Medical Group is a leading provider of specialized healthcare for women, babies, and children. Since 1979, they've grown into a national, multispecialty medical group with a commitment to coordinated and compassionate care, bolstered by investments in research, education, and safety.
Accurately translate patients’ medical records into standardized codes for diagnoses and treatments.
Ensure compliance with legal, regulatory, and organizational standards.
Ensure claims are processed correctly and on time through clear communication and efficient management of records.
Dignity Health Medical Foundation provides comprehensive health care services. They have care centers throughout California and are affiliated with Dignity Health, one of the largest health systems in the nation. They strive to create purposeful work settings where staff can provide great care, while advancing in knowledge and experience through challenging work assignments and stimulating relationships.
Conduct audits of medical coding to ensure compliance with standards.
Develop and deliver education to improve documentation quality and coding accuracy.
Assist with internal and external audit preparation and response.
Sprinter Health reimagines how people access care by bringing it directly into their homes. They have supported more than 2 million patients across 22 states, completed over 130,000 in-home visits, and maintained a 92 NPS.
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.
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.
Conduct objective medical case reviews using standardized assessment criteria.
Evaluate the timeliness and appropriateness of care provided.
Identify quality improvement opportunities.
Broadway Ventures transforms challenges into opportunities with expert program management, cutting-edge technology, and innovative consulting solutions. It is an 8(a), HUBZone, and Service-Disabled Veteran-Owned Small Business (SDVOSB).
Management and oversight of a quality team conducting quality assurance activities.
Responsible for the successful execution of the Quality Improvement Program in accordance with CMS requirements.
Plans, organizes, and directs activities of Clinical Quality, including planning, training, and staff development.
HealthEdge is committed to workforce diversity and actively encourages all qualified persons to seek employment. They provide effective and efficient solutions to complex business problems.