Provide one-on-one peer support to individuals with SUD, using personal lived experience to motivate members.
Develop individualized recovery plans and collaborate with clinical teams to ensure integrated care.
Maintain accurate documentation, advocate for resources, and participate in ongoing training.
Spring Health is a global mental health company eliminating barriers to mental health. They reach over 170 million people worldwide and foster a culture of AI fluency and human-centered care.
Conduct coverage reviews and render determinations based on member benefits and medical policies.
Document clinical findings and actions in accordance with regulatory and accreditation requirements.
Engage in peer-to-peer discussions with providers and collaborate on benefit determinations.
Capital Blue Cross is a health insurance company that provides coverage and services. They are consistently voted as one of the Best Places to Work in Pennsylvania, reflecting a positive culture.
Review medical records to develop concise clinical reviews supporting authorization and reimbursement.
Facilitate communication with payors to ensure appropriate utilization management decisions.
Collaborate with interdisciplinary team to prevent denials and optimize patient care.
West Virginia University Health System is West Virginia’s largest health system, providing comprehensive healthcare services. With over 35,000 employees and 25 hospitals, it is the state's largest employer and offers a collaborative, patient-centered culture.
Perform clinical reviews for medical necessity, level of care, and authorization compliance.
Prepare and submit high-quality appeals related to DRG downgrades and clinical validation denials.
Apply payer-specific guidelines and document review findings accurately in designated systems.
CorroHealth helps clients exceed their financial health goals through scalable revenue cycle solutions and clinical expertise. The company builds long-term careers by investing in team members' professional development and personal growth.
Conduct utilization review to determine medical necessity of admission and continued stay using established criteria.
Collaborate with payers to secure authorization and work with multidisciplinary teams to reduce length of stay and readmissions.
Provide clinical data for denial management, appeal letter writing, and trend identification to improve processes.
OHSU is Oregon's only public academic health center, providing patient care, groundbreaking research, and training health professionals. As Portland's largest employer, we offer diverse opportunities in a system of hospitals and clinics, committed to building an anti-racist, multicultural institution.
Authorizes and reviews utilization of mental health and substance abuse services in inpatient and outpatient settings.
Provides telephone triage, crisis intervention, and discharge planning while collaborating with clinical teams and providers.
Analyzes utilization data, participates in quality improvement projects, and advocates for patient treatment needs.
Magellan Health is a managed care organization focused on behavioral health and substance abuse services. They are a large employer with a culture centered on caring, professional growth, and employee wellbeing.
Review medically complex claims, pre-authorization requests, appeals, and fraud and abuse referrals.
Assess payment determinations using clinical information and established guidelines.
Evaluate medical necessity, appropriateness, and reasonableness for coverage and reimbursement.
Broadway Ventures transforms challenges into opportunities with expert program management, cutting-edge technology, and innovative consulting solutions. As an 8(a), HUBZone, and Service-Disabled Veteran-Owned Small Business, we empower clients with tailored solutions, operating with integrity and collaboration.
Provide psychiatric diagnostic evaluations and psychopharmacological management for general mental health and substance use disorders across all ages.
Deliver direct care via telemedicine, including medication-assisted treatment and supportive psychotherapy with a trauma-informed approach.
Coordinate care with multidisciplinary teams including PCPs, pediatricians, and peer support staff, completing rating scales and treatment plans.
Ascend Healthcare provides fully integrated psychiatric and behavioral health services nationwide, partnered with community health centers. The company fosters a patient-first culture with remote work, career growth, and a collaborative team environment.
Manage end-to-end credentialing and payer enrollment for behavioral health providers and facilities.
Serve as subject matter expert on credentialing requirements, ensuring timely and compliant files.
Coordinate with HR, Talent Acquisition, and leadership to facilitate provider onboarding and resolve issues.
We are a leading provider of immediate-access behavioral health crisis care. We are physician-led and data-driven, with over 15 years of crisis care expertise, recognized as a national best practice.
Provide high quality, compassionate guidance in individual and group counseling sessions for opioid use disorder recovery.
Plan, oversee, and document patient recovery, including treatment plans, assessments, and aftercare coordination.
Act as a liaison between referral sources and patients, providing crisis intervention and case management duties.
Winston-Salem Comprehensive Treatment Center (CTC) is part of Acadia Healthcare's Comprehensive Treatment Centers, the leading provider of medication-assisted treatment in the nation. They provide compassionate, high-quality counseling and therapy to patients seeking recovery from Opioid Use Disorder.
Performing timely utilization review of healthcare services using approved medical necessity criteria.
Collaborating with medical directors, providers, and internal teams for compliant review processes.
Ensuring accurate documentation and communication of determinations within regulatory timeframes.
Guidehealth is a data-powered, performance-driven healthcare company focused on making healthcare affordable and improving patient health. It is a physician-led organization using AI and predictive analytics, with a culture of accountability, growth, innovation, and empathy.
Lead the treatment team alongside providers and care navigators to coordinate members' recovery.
Conduct intake assessments and clinical assessments to evaluate program appropriateness.
Utilize custom EMR to document progress efficiently and ensure compliance with admission requirements.
Groups Recover Together makes opioid addiction treatment respectful, accessible, and affordable through community support, weekly group therapy, and medication. The company empowers members with a coordinated care team to regain control of their lives.
Conduct intake assessments to evaluate Member readiness and determine appropriate level of care.
Facilitate group and one-on-one counseling sessions using Affect’s evidence-based curriculum.
Maintain timely, accurate documentation in our electronic medical record (EMR) system.
Affect is transforming addiction treatment through an innovative, evidence-based digital program specializing in substance use disorders and mental health. The company is a mission-driven startup with a supportive team culture focused on impact, collaboration, and innovation.
Conduct medical necessity reviews for inpatient admissions and post-acute services using evidence-based guidelines.
Lead peer-to-peer discussions with attending physicians to clarify clinical documentation and support appropriate care decisions.
Collaborate with utilization management and care management teams to ensure consistent, cost-effective care.
Our partner company provides utilization management services for Medicare Advantage members, focusing on evidence-based clinical decision-making. It operates with a collaborative, matrixed team and emphasizes regulatory compliance and patient-centered care.
Enroll practitioners in health plans accurately and timely, monitoring progress and ensuring completion.
Validate and maintain provider enrollment forms, applications, and tracking systems.
Communicate with internal teams to meet enrollment goals and target start dates.
Pediatrix Medical Group is one of the nation's largest providers of prenatal, neonatal and pediatric services. With a focus on team approach, the company is home to a diverse group of business professionals dedicated to improving patient lives.
Conduct complex medical review of Medicare claims for Inpatient Rehabilitation Facility services.
Perform pre-claim review determinations and evaluate Additional Documentation Request responses.
Communicate determinations to providers and meet production-driven turnaround requirements.
Broadway Ventures is a small business that provides program management, technology, and consulting solutions to government and private sector clients. As a Service-Disabled Veteran-Owned Small Business, they emphasize integrity, collaboration, and excellence.
Provide telehealth therapy to the Medicaid population and accrue clinical hours toward licensure.
Enjoy flexible scheduling with a steady caseload and consistent paycheck, paid for all work including documentation and client no-shows.
Receive employer-paid supervision, health benefits, and administrative support for scheduling and billing.
Third Space Therapy combines the independence of private practice with the support of a group setting, focused on expanding Medicaid-covered behavioral healthcare. They are a growing practice looking for passionate Associate Therapists to provide telehealth therapy to the Medicaid population.
Provide behavioral health assessments and treatment including individual and family psychotherapy.
Act as a consultant and resource to hospital staff on behavioral health management.
Coordinate with complex care management and community support services.
Southcoast Health is a not-for-profit, charitable health system with multiple hospitals, clinics, and facilities across Southeastern Massachusetts and Rhode Island. They have been voted 'Best Place to Work' for 7 consecutive years, fostering inclusive and ethical workplaces.
Review and analyze Medicare claims sampled by the Department of Justice to determine correct coding and payment based on coverage and utilization.
Conduct in-depth claims analysis to detect fraudulent or abusive billing practices using ICD-10, CPT-4, and CMS guidelines.
Complete summary reports and communicate findings internally while maintaining confidentiality and compliance with DOJ and CMS regulations.
Empower AI provides AI-powered solutions for federal government agencies, helping them transform their workforce and operations. Headquartered in Reston, Va., the company has three decades of experience in Health, Defense, and Civilian missions and is recognized as a 2024 Military Friendly Employer.
Supervise associate therapists providing telehealth services to the Medicaid community.
Help associates accumulate clinical hours for full licensure with flexible scheduling.
Work remotely with dedicated administrative support and competitive monthly compensation.
Third Space Therapy combines the independence of private practice with the support of a group setting, focused on expanding Medicaid-covered behavioral healthcare. We are a growing team of licensed professionals dedicated to mentoring emerging therapists and providing accessible mental health services.