Provide case management addressing medical, social, psychological, physical, and spiritual needs of members.
Develop, implement, and monitor care plans in collaboration with PCP, caregivers, and team members.
Ensure members' needs are met through coordinated care and support.
Elderplan offers Medicare and Medicaid managed care health plans designed to keep members independent and living life on their own terms. As part of MJHS, it is a supportive community committed to excellence, respect, and high-quality personalized health care services.
Provide telephonic case management and utilization review for assigned consumers.
Develop, implement, and monitor individualized care plans to ensure quality and cost-effective outcomes.
Collaborate with healthcare providers, payors, and internal teams to coordinate care.
Cottingham & Butler helps clients through life's toughest moments by providing insurance and benefits solutions. The company fosters a culture of continuous improvement, seeking to hire, train, and grow the best professionals in the industry.
Responsible for using assessment and communication skills to engage patients in need of clinical support, determine priorities, and deliver patient-centered care.
Identify patient education needs through telephonic assessment and collaborate with healthcare teams to coordinate care and keep patients stable at home.
Serve as point of contact for patients, families, and providers, implementing interventions to improve health outcomes and reduce costs.
Vytalize Health is a value-based healthcare company that coordinates care for patients with chronic conditions, aiming to improve outcomes and lower costs. It is a rapidly growing organization with a startup culture, offering a dynamic environment.
Provide comprehensive case management services including assessing client needs, developing care plans, coordinating services, and monitoring progress.
Collaborate with healthcare professionals, insurance companies, and stakeholders to ensure seamless care coordination and favorable outcomes.
Maintain accurate documentation, educate clients and families on self-management, and stay current with industry best practices.
MVP Health Care is a not-for-profit health plan provider focused on creating a healthier future through innovation and equity. For over 40 years, they have served New York and Vermont communities with high-quality health plans and have been recognized as a Best Place to Work.
Build trusting relationships with patients and providers to address health barriers and coordinate care.
Navigate medical, behavioral, and social systems to connect patients with appropriate resources.
Support value-based care outcomes through proactive outreach, documentation, and quality measures.
Guidehealth is a data-powered, performance-driven healthcare company dedicated to operational excellence. As a growing and innovative organization, we operate with a high degree of agility.
Build meaningful relationships with patients and families to understand their goals and barriers.
Create personalized care plans addressing medical, behavioral, and social needs.
Coordinate care across providers and settings, ensuring safety, quality, and continuity.
Guidehealth is a data-powered, performance-driven healthcare company dedicated to making great healthcare affordable and improving patient health. As a physician-led organization with a high degree of agility, it employs a remote team and fosters a collaborative, mission-driven culture focused on continuous learning.
Collaborate with primary care providers to coordinate care for patients with multiple chronic conditions, ensuring high-quality care through telephonic and in-person outreach.
Conduct transitional care management including post-discharge follow-up and provide education on lifestyle coaching and dietary improvements.
Operate independently to achieve goals, attend regular care team meetings, and perform other duties as assigned.
Privia Health is a technology-driven national physician enablement company that collaborates with medical groups and health systems to optimize practices and improve patient care. The company is led by top industry talent and focuses on scalable operations and cloud-based technology to reduce healthcare costs and improve outcomes.
Complete biopsychosocial assessments to identify clinical, behavioral, and social needs.
Proactively identify and resolve care gaps in patient records, ensuring timely clinician review.
Coordinate referrals, follow-up appointments, and community-based care support services.
Knownwell provides weight-inclusive healthcare for all, offering weight management, primary care, nutrition counseling, and health coaching. They are backed by $50M in funding, scaling fast to expand access to evidence-based obesity care nationwide.
Implements and supports the philosophy, mission, values, standards, policies, and procedures of The Ohio State University Wexner Medical Center.
Functions within the multidisciplinary team to secure complex pre-authorizations and prevent/appeal clinical denials.
Utilizes clinical knowledge to interpret and apply medical necessity guidelines to determine appropriateness for services provided.
The Ohio State University is a top-20 public university with one of America’s leading academic health centers. They are a team of dedicated colleagues with access to boundless resources.
Act as the primary point of contact for patients, healthcare providers, and program stakeholders.
Manage patient access, reimbursement, and therapy support processes.
Build trusted relationships with healthcare professionals and ensure coordinated care.
A healthcare services organization that partners with patients and providers to navigate complex treatment processes. The culture is purpose-driven, collaborative, and inclusive, with an emphasis on improving health outcomes.
Provide exceptional customer service and build rapport with patients.
Serve as the new patient scheduling liaison for 16 clinics and telehealth visits across 20+ states.
Manage and schedule new patient appointments and promptly respond to patient inquiries.
Aligned Modern Health is changing the face of healthcare with a holistic, multi-disciplinary model offering evidence-based solutions. The company has 16 clinics across Chicago and suburbs, provides telehealth services in over 20 states, and prides itself on outstanding clinical outcomes and a five-star patient experience.
Identify, research, process, and resolve customer inquiries regarding health insurance benefits, claims, and eligibility.
Analyze medical records and apply medical necessity criteria to determine the appropriateness of benefit requests.
Maintain accurate records, meet quality and timeliness standards, and coordinate with internal departments and external organizations.
Blue Cross Blue Shield of Arizona provides health insurance products and services to individuals, families, and businesses, aiming to inspire health and make it easy. The company has been recognized as a Healthiest Employer and has transformed healthcare for over 80 years with teams in Phoenix, Tucson, Chandler, and Flagstaff.
Review Home Health prior authorization requests for medical necessity using CMS regulations and Clover clinical guidelines.
Perform initial and concurrent clinical reviews, ensuring appropriate care in the least restrictive setting.
Collaborate with providers and internal teams to support timely decision-making and positive member outcomes.
Clover Health is a healthcare company that uses data and technology to provide affordable, high-quality insurance plans for seniors. The company fosters a remote-first culture with a diverse and mission-driven team focused on improving member outcomes.
Manage patient physiological markers and provide clinical triage.
Conduct wellness calls and collaborate with care teams to set health goals.
Drive patient engagement and ensure adherence to RPM program standards.
Vivo Care is building a platform to make healthcare continuous, personal, and truly connected. It is a fast-growing startup with a culture of inclusion, collaboration, and innovation.
Provide telephone support to patients, healthcare professionals, and funding organizations regarding access, reimbursement, compliance, and support programs.
Manage assigned patient cases and projects while following established operational processes and service standards.
Maintain accurate case documentation within program databases, ensuring all activities and interactions are properly recorded.
This role is posted on behalf of a partner company, which manages all applications and next steps. The company focuses on healthcare support and improving patient access to therapies, with a collaborative culture and opportunities for professional growth.
Ensure acute hospital admissions have appropriate level of care and meet medical necessity.
Monitor patient progress in plan of care for continued stay.
Provide clinical information to payer to authorize acute hospital stay and continued services.
Piedmont Healthcare is a healthcare organization focused on patient outcomes. It offers a supportive culture with diverse teams, schedule flexibility, and comprehensive benefits, fostering employee growth and well-being.
Serve as a vital link between patients and healthcare services, coordinating care across primary, specialty, and behavioral health divisions.
Conduct patient assessments and community outreach to engage underserved populations in the Bronx, addressing barriers to care.
Utilize remote patient monitoring tools and electronic health records to track patient progress and adjust care plans.
Essen Health Care is the largest privately held, multispecialty medical group in New York, providing high-quality, compassionate care to underserved residents. Founded in 1999, the company has grown to 50+ locations with 500+ providers, focusing on a population health model and a supportive team environment.
Take inbound calls from patients, providers, and members to assist with healthcare needs, insurance questions, and triage support.
Provide empathetic, patient-focused service in a remote environment, managing calls that may involve emergent situations.
Support members with insurance navigation, including changing primary care physicians, locating urgent care clinics, and obtaining prescription authorizations.
Carenet Health has pioneered healthcare consumer engagement for over 30 years, interacting with 1 in 3 Americans daily to deliver positive experiences and improve outcomes. We foster a culture of collaboration, creativity, and accountability, empowering growth through trust and opportunity.