Perform medical necessity reviews of clinical documentation to determine appropriateness of inpatient and outpatient services.
Develop relationships with medical providers and health plans to confirm adherence to policies and guidelines.
Stay updated on technology changes, regulatory issues, and medical practices through ongoing training.
Trend Health Partners is a tech-enabled payment integrity company that facilitates collaboration between payers and providers to reduce waste and improve healthcare access. It promotes a collaborative and innovative work environment as a dynamic, growing organization.
Review patient records and healthcare documentation to ensure compliance with regulatory standards.
Evaluate accuracy and completeness of clinical documentation, including OASIS guidelines and coding.
Collaborate with interdisciplinary teams to enhance patient outcomes through quality improvement initiatives.
Jobgether is a job platform that uses AI-powered matching to connect candidates with hiring companies. They partner with various employers to manage recruitment processes.
Lead clinical quality strategy and client audit readiness for high-stakes client and consultant engagements.
Build longitudinal quality assurance systems to monitor member journeys and ensure service reliability.
Drive AI-enabled quality surveillance and pattern detection to scale quality operations.
Included Health is a healthcare company that delivers integrated virtual care and navigation, breaking down barriers to provide high-quality care for every person. The company is remote-first and offers a comprehensive benefits package, aiming to raise the standard of healthcare for everyone.
Provide study oversight as primary liaison between CRAs, internal staff, site staff, client personnel, and external vendors.
Ensure clinical monitoring activities comply with SOPs, regulations, GCP, KPIs, and study-specific requirements.
Develop and manage clinical plans and guidelines, including the clinical monitoring plan and study timelines.
ProTrials is a women-owned, WBENC-certified Contract Research Organization (CRO) that has been a trusted partner in clinical research since 1996, supporting research behind innovative treatments in pharmaceutical, biotech, and medical device industries. They foster a collaborative community where team members feel valued, supported, and empowered to make a meaningful impact on global health.
Supervise day-to-day operations of clinical compliance auditors and specialists, serving as a liaison to senior management.
Coordinate orientation, training, and performance monitoring for clinical compliance auditors to promote professional growth.
Oversee development of UM and PHM agenda, audit guidelines, and ensure adherence to denial processes and compliance requirements.
Guidehealth is a data-powered, performance-driven healthcare company dedicated to operational excellence, aiming to make healthcare affordable and improve patient health. It is a physician-led, remote-first organization that leverages AI and predictive analytics to empower partners in delivering high-quality, value-based care.
Perform clinical validation and medical record abstraction to ensure accuracy and compliance with CMS quality measures.
Identify and resolve data discrepancies in collaboration with internal teams and external vendors like Oracle Health.
Support timely regulatory submissions and cross-train across validation and abstraction functions for workload flexibility.
Banner Health is a large, nonprofit health care system in the US, providing hospital services, primary care, and research across multiple communities. With a network of hospitals and clinics, they employ skilled professionals using advanced technology to improve patient care.
Review and evaluate medical record documentation for completeness, accuracy, and compliance.
Collaborate with physicians, nurses, and coding professionals to ensure appropriate clinical documentation.
Identify opportunities for documentation improvement to support coding accuracy, reimbursement, and clinical outcomes.
We improve the quality and accuracy of clinical documentation through expert CDI consulting. Our collaborative, mission-driven team offers opportunities for continuous learning and professional growth.
Performs utilization review of cases to determine if the request meets medical necessity criteria in accordance with medical policies.
Collaborates with client personnel to resolve customer concerns and facilitates resolution of escalated cases.
Maintains written documentation per HealthHelp’s policy and ensures compliance with HIPAA, state, and federal regulations.
WNS, part of Capgemini, is an Agentic AI-powered leader in intelligent operations and transformation, serving more than 700 clients across 10 industries. With three global headquarters, operations in 13 countries, 65 delivery centers, and more than 66,000 employees, WNS combines scale, expertise, and execution to create meaningful, measurable impact.
Support quality, safety, and compliance by identifying documentation and workflow improvements.
Process physician orders within the EMR and ensure verbal orders meet documentation requirements.
Manage end-of-episode documentation, including discharge reports and OASIS visits.
Adaptive Home Health is an AI-native physical care platform transforming US healthcare, starting with home health. The company combines a world-class AI team with healthcare veterans to build a new type of healthcare company that delivers care at the speed of an AI company.
Review inpatient and outpatient medical records to ensure accurate and compliant clinical documentation.
Collaborate with physicians and clinical teams to clarify diagnoses and support proper coding.
Maintain productivity targets and contribute to provider education initiatives to improve documentation quality.
Jobgether is an AI-powered job matching platform that connects candidates with hiring companies. It processes applications using AI to ensure fair review and shares top candidates with employers.
Provide clinical leadership and medical oversight for audit programs involving governmental and commercial payer claims.
Evaluate medical necessity, level of care, coding accuracy, and documentation sufficiency using payer policies and clinical standards.
Support audit methodologies, clinical validation frameworks, and quality assurance to ensure regulatory alignment and defensibility.
Machinify is a leading healthcare intelligence company delivering value, transparency, and efficiency to health plan clients. Deployed by over 85 health plans representing more than 270 million lives, they bring an AI-powered platform alongside best-in-class expertise.
Facilitate improvement in provider-based clinical documentation accuracy to reflect patient acuity and severity.
Conduct concurrent record reviews and formulate compliant documentation queries to improve accuracy.
Educate clinicians and facility management on documentation opportunities and coding reimbursement issues.
Banner Health is a large nonprofit health care system with hospitals, clinics, and research centers across multiple states. They focus on skilled and compassionate care using advanced technology to improve patient outcomes.
Oversee hospice intake compliance and execute clinical audit activities across the organization.
Conduct pre-bill chart audits to ensure Medicare regulatory compliance and documentation accuracy.
Collaborate with clinical and operational teams to strengthen audit readiness and support revenue cycle efficiency.
Ennoble Care is a mobile primary care, palliative care, and hospice service provider operating across multiple states. The company prioritizes high-quality care for chronic conditions and limited mobility, embodying the motto "To Care is an Honor."
Build the QA framework to measure agent compliance and service excellence within a high-growth healthcare environment.
Ensure 100% adherence to clinical protocols, insurance verification accuracy, and HIPAA privacy standards during every member touchpoint.
Identify trends in member friction points and collaborate with cross-functional teams to resolve operational issues.
OneImaging is a concierge radiology service that provides a premium-quality network of over 5,000 vetted providers across 48 states, reducing imaging costs by 60-80%. They are a high-growth tech-enabled healthcare company focused on improving patient access and eliminating surprise bills.
Perform in-house and remote monitoring activities for clinical trials, ensuring compliance with regulatory requirements and study protocols.
Support study start-up, site selection, and document tracking while assisting CRAs with on-site and remote monitoring.
Communicate with investigative sites to resolve queries and maintain study tracking tools for deviations, SAEs, and data discrepancies.
Jobgether is an AI-powered job matching platform that connects candidates with hiring companies. The environment is collaborative, international, and focused on improving patient outcomes through high-quality research.
Conduct quality control reviews of participant visits and source documentation in the CRIO eSource system to ensure compliance with GCP, ALCOA principles, and client standards.
Identify missing documentation, inconsistencies, protocol deviations, and transcription errors, and document findings in tracking systems.
Collaborate with site personnel to communicate findings, support corrective actions, and contribute to continuous improvement initiatives.
UniTriTeam is a women-owned global workforce solutions organization specializing in clinical research operations, technology, and strategic staffing support. The team is collaborative, accountable, and committed to delivering excellence and integrity.
Support GCP/GCLP/GVP audits for investigational sites, internal systems, and clinical service providers, including planning, coordination, and reporting.
Assist with commercial inspections, inspection readiness activities, and GCP compliance tasks such as investigations and change controls.
Maintain a continuous improvement mindset and represent the Clinical Quality Assurance Team in cross-functional projects.
Iovance Biotherapeutics is a biotechnology company pioneering tumor infiltrating lymphocyte (TIL) therapy for cancer patients. The company is a clinical-stage organization with a strong focus on innovation and collaboration in a fast-paced environment.
Serve as the primary point of contact and partner with investigative sites to ensure high-quality clinical trial conduct.
Conduct site evaluation, training, monitoring, and closure activities in compliance with regulations, GCPs, and SOPs.
Utilize risk-based monitoring and site engagement strategies to improve data integrity, compliance, and study performance.
AbbVie discovers and delivers innovative medicines and solutions across immunology, oncology, neuroscience, and aesthetics. A large global biopharmaceutical company, AbbVie fosters a culture of innovation and integrity to transform patients' lives.
Supervise daily operations of clinical compliance auditors and specialists.
Assist in developing coordinated team processes and managing UM and PHM plan adherence.
Serve as clinical services liaison to senior management and ensure timely documentation.
Guidehealth is a data-powered healthcare company focused on operational excellence and value-based care. They emphasize empathy, AI, and collaboration, with a remote-first culture.
Perform medical claims audit reviews with a focus on the Home Health sector, applying medical review guidelines and documenting findings.
Collaborate with the audit team to identify vulnerabilities, generate audit letters, and support findings during appeals.
Maintain knowledge of coding systems (ICD-10, CPT-4, HCPCS) and regulatory changes to ensure high-quality, deadline-driven work.
Machinify is a leading healthcare intelligence company that delivers value, transparency, and efficiency to health plan clients using an AI-powered platform. Deployed by over 85 health plans, including many of the top 20, and representing more than 270 million lives, the company fosters a collaborative, fast-paced remote culture.