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.
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.
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.
Manage Health Services staff, promoting a healthy work and learning environment while ensuring adequate training and coverage.
Direct quality improvement projects, model a caring philosophy, and champion age-appropriate developmental considerations.
Collaborate with leadership to monitor expenses, ensure budget compliance, and support the integrated model of care.
Imagine Pediatrics is a tech-enabled, pediatrician-led medical group reimagining care for children with special health care needs. The company offers competitive benefits and fosters a culture guided by core values like Children First and Earn Trust.
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.
Analyze "trigger reports" to identify potential financial exposure early in the claims process.
Gather clinical information to evaluate liability and make recommendations to stakeholders.
Provide cost containment by managing Stop Loss claims and negotiating prices for medical services.
Ullico is the only labor-owned insurance and investment company and has been a partner of the labor movement for over 95 years. The company provides insurance products for members, leaders, and employers, as well as investments.
Lead and develop the EMR Success team, managing EMR Integration Specialists and driving customer success across the full integration lifecycle.
Serve as the technical point for triage and escalation, partnering with internal teams to unblock dependencies and improve integration experience.
Build scalable processes, metrics, and cross-functional partnerships to optimize EMR implementation and support workflows.
BillionToOne is a molecular diagnostics company that develops transformative diagnostic tests for prenatal and cancer care using its QCT molecular counting technology. The company is publicly traded on Nasdaq with over 700 employees and a culture of transparency, innovation, and compassion.
Oversee the development and quality of undergraduate nursing content across NCLEX-RN and PN products.
Manage a team of content leads and editors, ensuring accuracy and alignment with exam standards.
Collaborate with cross-functional teams including marketing and technology on content initiatives.
Blueprint is an education technology company that uses technology and data to create personalized learning experiences. The company fosters a remote-first culture with a focus on autonomy, growth, and collaboration, and is committed to diversity and inclusion.
Lead and manage daily performance of assigned frontline teams, ensuring adherence to quality, productivity, and service standards.
Analyze key operational metrics and trends to identify risks and improvement opportunities.
Foster employee growth through structured coaching, mentoring, and ongoing performance feedback.
Carenet Health is a healthcare services company that provides patient engagement and care coordination solutions. The company operates with a focus on delivering a seamless member experience through its BPO operations, though specific size and culture details are not provided.
Establishes and implements the domestic managed care strategy for medical case management services.
Develops resource models, drives continuous improvement, and manages operational metrics to meet financial objectives.
Manages a network of providers to ensure quality and cost-effective medical management services.
Liberty Mutual is a global insurance company providing property and casualty insurance. The company has a large workforce and emphasizes an inclusive culture with comprehensive benefits and professional development opportunities.
Partner with Product, Engineering, Marketing and Clinical teams to execute and improve Pharmacy Care and Weight Health solution initiatives.
Identify and champion operational issues, driving root cause analysis and scalable process improvements across both solution lines.
Program manage teams to initiate, plan, execute, and monitor initiatives that drive operational excellence and improve the member experience.
Transcarent is the One Place for Health and Care, bringing medical, pharmacy, and point solutions together with the WayFinding experience, the first generative AI-powered health and care platform. With over 1,700 employers and health plans, they serve 21 million Members and are committed to transforming how people access and experience care.
Evaluates member health metrics and professional resources to inform UM/CM initiatives and programs.
Refers members and providers to G.E.H.A resources and programs, as indicated, maximizing their health plan benefits.
Monitors and evaluates program effectiveness, tracks relevant metrics, and reports outcomes.
Government Employees Health Association (G.E.H.A) is a nonprofit member association providing health and dental benefits to millions of federal employees and retirees since 1937. G.E.H.A is headquartered in Lee's Summit, Missouri, offering hybrid and work-from-home options for many roles.
Lead and inspire a team of Patient Support Specialists.
Establish and refine team KPIs related to outreach volume and scheduling conversions.
Partner with clinical, engagement, and product teams.
Zócalo Health is the first tech-driven provider built specifically for Latinos, by Latinos. They are developing a new approach to care that is designed around shared and lived experiences and brings care to the community. The company was founded in 2021 and is backed by leading healthcare and social impact investors.
Provide executive oversight of all clinical programs, including Behavioral Health and EAP services, establishing strategic direction and quality frameworks.
Lead and supervise AVP-level clinical leaders, ensuring accountability and cross-functional alignment across clinical operations.
Develop clinical strategies, policies, and procedures, oversee utilization management, and drive quality improvement initiatives.
Uprise Health transforms the delivery and accessibility of mental and behavioral healthcare, bringing whole person care to individuals worldwide. The company values compassion, integrity, collaboration, velocity, and advocacy, and seeks to foster a culture of care and support.
Lead client onboarding and coding integration programs, ensuring smooth transitions and long-term operational success.
Oversee outpatient and physician coding operations, ensuring accuracy, compliance, and productivity.
Partner with teams to align coding practices with revenue cycle objectives and drive performance improvements.
Jobgether uses AI-powered matching to connect candidates with hiring companies. They focus on efficient, objective candidate evaluation and data privacy compliance.
Lead Medicaid operations and serve as the subject matter expert shaping service delivery and regulatory compliance.
Own client relationships, drive operational excellence, and implement process improvements across the team.
Develop and coach a high-performing remote team, fostering accountability, collaboration, and continuous growth.
Model N is the leader in revenue optimization and compliance for pharmaceutical, medtech, and high-tech innovators. With over 150 customers in more than 120 countries and 25+ years of experience, the company fosters a culture of innovation and customer success.
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.
Perform concurrent inpatient utilization review using InterQual criteria to determine medical necessity.
Engage in clinical collaboration with physicians and care teams to support appropriate level-of-care decisions.
Maintain documentation, comply with regulations, and ensure quality customer service.
WNS, part of Capgemini, is an Agentic AI-powered leader in intelligent operations serving over 700 clients across 10 industries. With over 66,000 employees across 13 countries and 65 delivery centers, the company combines scale and expertise to create meaningful impact.
Supervise a team of 10-15 direct reports under the ECM team to ensure high-quality care management services.
Oversee client outreach, enrollments, and creation of Individual Care Plans, serving as an escalation point.
Drive the team to meet key performance indicators (KPIs) and collaborate with Directors on process improvements.
Vynca provides comprehensive care for individuals with complex needs, focusing on more quality days at home. They are a close-knit community guided by core values of Excellence, Compassion, Curiosity, and Integrity.
Oversee prior authorization technicians and administrative PA functions.
Analyze data and provide staffing, workflow, and system enhancement recommendations.
Investigate/resolve escalated issues from clients and providers.
Judi Health is an enterprise health technology company providing a suite of solutions for employers and health plans. They have a comprehensive Enterprise Health Platform that consolidates all claim administration-related workflows in one scalable, secure platform.
Collaborate with physicians, APPs, and interdisciplinary team members to manage a patient panel and address specialized needs post-hospitalization.
Perform assessments and develop comprehensive care plans based on individual patient values, goals, and preferences.
Coordinate patient care delivery with clinicians, network providers, contracted vendors, and community-based services.
Evergreen Nephrology partners with nephrologists to transform kidney care through a value-based, person-centered, holistic approach. The company provides interdisciplinary clinical resources and analytical tools to improve patient outcomes, operating with a team that values innovation and comprehensive care.