Provides clinical oversight and medical necessity reviews for home health, DME, and related services using evidence-based guidelines.
Conducts peer to peer consultations and adverse determinations when clinical criteria are not met to support quality outcomes.
Collaborates with health plan leadership, participates in committees, and achieves SLA metrics for client performance guarantees.
CareCentrix provides clinical oversight and utilization management for home health, DME, home infusion therapy, and sleep medicine services. The company has an award-winning culture that values care, integrity, excellence, and innovation, operating with a drug-free workplace and equal opportunity commitment.
Perform concurrent and retrospective reviews on all facility and appropriate home health services.
Monitor level and quality of care and proactively manage acutely and chronically ill patients.
Act as liaison to Plan Medical Director and coordinate interdisciplinary approach.
Curana Health is a national leader in value-based care for senior living communities and skilled nursing facilities. Founded in 2021, they serve 200,000+ seniors in 1,500+ communities across 32 states with a team of over 1,000 clinicians.
Provide clinical review and correspondence for utilization management, including medical necessity reviews and member communications.
Collaborate with Medical Directors to ensure evidence-based decisions that meet NCQA and CMS standards.
Maintain productivity and quality while working 100% remotely in a fast-paced environment.
Cohere Health’s clinical intelligence platform and agentic AI-powered solutions connect health plans’ strategic goals and providers’ needs, optimizing the speed, cost, and quality of care. With over 250 employees, the company fosters a supportive, growth-oriented environment and has been named to the Inc. 5000 list and a Top 5 LinkedIn Startup.
Conducts utilization review to determine medical necessity of admission and continued stay using established criteria.
Communicates with payers to secure authorization and negotiate medical necessity decisions.
Educates providers on documentation requirements and participates in strategies to reduce length of stay and readmissions.
OHSU is Oregon’s only public academic health center, providing patient care and conducting groundbreaking research while training health care professionals. As Portland’s largest employer, it offers a diverse and inclusive culture with opportunities for growth across Oregon and Southwest Washington.
Conduct video-based appointments for non-emergency issues, treating patients in internal medicine and related areas such as urgent care, gynecology, and obesity care.
Design personalized treatment plans supported by current clinical guidelines and record encounters using efficient EHR tools for accurate follow-up and prescriptions.
Collaborate remotely with other clinicians to deliver coordinated, high-quality care and stay updated on telehealth standards and evolving best practices.
DrHouse is building a new model of virtual healthcare that is fast, accessible, and centered on both patient and provider experience. They are a rapidly expanding digital health company with a diverse, mission-driven community of clinicians committed to equitable healthcare access.
Perform clinical reviews for medical necessity, level of care, and authorization-related denials.
Apply payer-specific guidelines and internal policies to support clear, defensible clinical narratives.
Meet assigned turnaround times and document findings accurately in designated systems.
CorroHealth helps clients exceed their financial health goals through scalable reimbursement solutions and clinical expertise, leveraging technology and analytics. The company builds long-term careers by investing in professional development and personal growth, fostering a culture of accountability and success.
Conduct thorough patient assessments and develop personalized treatment plans via video visits
Collaborate with a multidisciplinary care team to deliver the highest standards of care
Educate patients on preventive care and wellness using evidence-based strategies
Allara is a comprehensive women's health provider specializing in expert, longitudinal care for hormonal, metabolic, and reproductive conditions. Trusted by over 60,000 women nationwide, it is one of the fastest-growing women's health platforms in the U.S.
Provide high-quality preventative, acute, and chronic care in a fully-remote, virtual setting.
Elevate remote care by delivering compassionate, meaningful patient encounters.
Manage a dedicated patient panel as their primary care physician, including population health initiatives.
K Health partners with top hospital systems to provide AI-powered virtual primary care clinics, aiming to expand access for underserved communities. The company is backed by nearly $400 million from leading investors and is headquartered in New York City.
Analyze denied insurance claims and apply clinical reasoning to determine appeal merit.
Draft persuasive, medically sound appeal letters to recover denied revenue.
Collaborate with legal team to ensure appeals are compelling and complete.
Ternium specializes in resolving complex healthcare insurance claim denials and delays for hospitals. They have a dedicated, mission-driven team and value diversity and inclusion.
Lead and oversee the Group Health Operations Management team, ensuring effective execution of utilization management services and operational workflows.
Drive achievement of key client performance metrics, including turnaround time, quality indicators, peer-to-peer success rates, and overturn rates.
Manage overall division profitability, including ownership of P&L performance and financial objectives.
Jobgether is a platform that uses AI-powered matching to connect candidates with job opportunities. They operate remotely and emphasize efficient, data-driven hiring processes.
Conduct virtual visits with older adults and review their medical history
Identify health-related social needs (HRSNs) as part of care planning
Create and update care plans that guide Community Care Advocates in providing community health support
Papa is a new kind of care built on human connection, pairing older adults with trained companions to reduce loneliness and improve health. Founded in 2017 and headquartered in Miami, Papa is a physician-led practice backed by major investors and focused on integrating medical and social care.