Participate in provider case reviews to identify trends and deficits.
Coach providers and participate in client meetings to support expectations.
Contribute to workflow design, QA improvements, and risk management.
Amwell transforms healthcare with technology and people. They aim to provide convenient, affordable, and effective care, serving large healthcare organizations in the U.S. and worldwide.
Utilize advanced clinical judgment to triage patient symptoms per protocol.
Conduct thorough reviews of refill requests and abnormal lab results.
Lead follow-up care for positive PHQ-9 screenings, ensuring patients are safely navigated to the appropriate level of care.
Form Health is a virtual obesity medicine clinic delivering multi-disciplinary evidence-based obesity treatment through telemedicine. Founded in 2019, Form Health is a venture-backed innovative startup with an experienced clinical and leadership team, deeply invested in creating a culture where every employee is valued and we learn and improve together.
Responsible for coordination of services for members, emphasizing education/self-management and quality care. \n- Assesses member needs, reviews service options, develops and implements care plans, and coordinates resources. \n- Manages a caseload of moderate-high risk members with complex medical/behavioral/psychosocial needs.
Capital Blue Cross is committed to improving the health and well-being of our members and the communities in which they live. They offer flexibility, prioritize health and well-being, and encourage employees to volunteer in their community.
Reviews pre-admissions for correct classification and admission order.
Performs Utilization Review for each patient on their assigned daily census using established medical necessity guidelines.
Communicates with payers regarding authorization and medical necessity, utilizing excellent negotiating skills.
Oregon Health & Science University values a diverse and culturally competent workforce. They are an equal opportunity, affirmative action organization that does not discriminate against applicants.
Serve as senior escalation point for client performance.
Lead Quarterly Business Reviews (QBRs).
Ternium RCM specializes in resolving complex healthcare insurance claim denials and delays. They empower hospitals and health systems by optimizing their revenue cycle, allowing them to focus on patient care. The company delivers outstanding results and enhances the patient experience.
Oversee provider credentialing, provider licensing, payer contracting, and network expansion.
Lead end-to-end provider credentialing, provider licensing and recredentialing for MDs and NPs.
Manage relationships with credentialing and contracting vendors.
Sunrise Group is building the future of sleep health by combining innovative technology with expert care. They are a fast-growing team across the US and Europe, backed by more than $50M (€46M) from leading investors including Amazon’s Alexa Fund, Eurazeo, Kurma, and VIVES.
Review daily inpatient and observation admissions to determine appropriate status.
Collaborate with physicians, case management, and insurance partners.
Utilize electronic medical records to support documentation, review, and reporting.
Logan Health aims to deliver quality, compassionate care for all, reimagining health care through connection, service and innovation. They value kindness, collaboration, trust, and strive for excellence in a supportive, mission-driven nursing culture.
Responsible for complete, accurate and timely processing of all designated claims.
Investigating denial sources, resolving and appealing denials which may include contacting payer representatives.
Drive toward achievement of department’s daily and monthly Key Performance Indicators (KPIs), requiring a team focused approach to attainment of these goals.
Privia Health is a technology-driven, national physician enablement company that collaborates with medical groups, health plans, and health systems to optimize physician practices, improve patient experiences, and reward doctors for delivering high-value care in both in-person and virtual settings. The Privia Platform is led by top industry talent and exceptional physician leadership.
Empowers patients toward optimal health through remote support and collaborative care coordination.
Assesses patient needs, develops personalized care plans, and provides direct clinical coaching.
Monitors progress, coordinates diverse services, and leverages telehealth, tracking compliance.
St. Joseph's Hospital and Medical Center, located in Phoenix, Arizona, is a 571-bed non-profit hospital offering various health services. Founded in 1895, it is known for quaternary care, medical education, and research, and it consistently ranks among the top hospitals in the U.S.
Conduct thorough assessments of patients' needs and develop treatment plans.
Monitor treatment effectiveness and adjust plans while documenting outcomes.
Advocate for patients to ensure quality care delivery and assist in cost reduction.
The company provides remote case management nursing services. The posting mentions an engaging company culture that values diversity and continuous learning.
Lead one of Rula’s most critical operational functions.
Own end-to-end credentialing and enrollment outcomes.
Partner across the company to ensure providers are credentialed and enrolled accurately, compliantly, and efficiently.
Rula is dedicated to treating the whole person, not just the symptoms and aim to create a world where mental health is no longer stigmatized or marginalized, but rather is embraced as an integral part of one's overall well-being. Rula is a remote-first company that values diversity, equity, and inclusion.
Ensure excellence in revenue cycle solution delivery across all new and existing customer deployments.
Recruit, mentor, and lead a high-performing team of client-facing revenue cycle solution consultants.
Partner with Implementation, Product, and Engineering teams to align complex solutions with product strategy and client timelines.
SmarterDx, a Smarter Technologies company, builds clinical AI that is transforming how hospitals translate care into payment. Founded by physicians in 2020, their platform connects clinical context with revenue intelligence, helping health systems recover millions in missed revenue, improve quality scores, and appeal every denial.
Review dialysis and transplant-related medical records to assess quality-of-care concerns.
Provide clinical expertise during patient complaint and grievance investigations.
Participate in assessments of healthcare facilities’ quality improvement readiness and safety programs.
Jobgether is a platform that connects job seekers with companies. They utilize AI-powered matching to ensure applications are reviewed quickly and fairly.
Supervise, direct and evaluate a diverse group of health care professionals to assure effectiveness of care coordination activities.
Develop audit plans and tools for teams to ensure compliance with state contracts on performance metrics and to ensure member needs are met.
Interview, hires, mentors, evaluates, coaches and manage performance for a diverse care coordination team.
Humana Inc. is committed to putting health first for its teammates, customers, and company. Through Humana insurance services and CenterWell healthcare services, they aim to make it easier for the millions of people they serve to achieve their best health.
Provides billing support for the Sandstone Care billing team.
Responsible for verification of benefits, billing data, claims submission, claim corrections, claim re-submissions, claim follow up and appeals.
Generates revenue by making payment arrangements, collecting accounts, monitoring and pursuing delinquent accounts.
Sandstone Care is committed to providing accessible, affordable, and high-quality mental health and addiction treatment services. They strive to create a diverse and inclusive workplace where all employees feel valued, respected, and empowered.
Complete timely review of healthcare services using appropriate medical criteria to support determinations.
Document clinical findings and rationale clearly and accurately in accordance with federal/state regulations, URAC standards, and Guidehealth policies.
Communicate precertification and concurrent review decisions—verbally and in writing—to required parties within defined timeframes.
Guidehealth is a data-powered, performance-driven healthcare company dedicated to operational excellence. Driven by empathy and powered by AI and predictive analytics, Guidehealth leverages remotely-embedded Healthguides™ and a centralized Managed Service Organization to build stronger connections with patients and providers.
Responsible for daily operations of direct reports while driving operational initiatives.
Leads clinical implementation efforts within an assigned team or partner for new technologies and workflows.
Drives change management and adoption of new tools and workflows at team level by partnering with training and peer leaders.
Twin Health empowers people to improve and prevent chronic metabolic diseases, like type 2 diabetes and obesity, with a new standard of care, applying AI Digital Twin technology exclusively toward metabolic health. The company has been recognized for its innovation and culture and is scaling rapidly across the U.S. and globally.
Review clinical documentation for accuracy and compliance.
Evaluate CDI program effectiveness and identify gaps.
Provide feedback to improve documentation quality.
UASI has over 40 years of experience and enduring partnerships with its valued clients. They are proud of the stability they've built and the long-term success of their dedicated team.
Assists in development and maintenance of an efficient UM program to meet the needs of health plan members commensurate with company values.
Perform clinical reviews (i.e., part A, B, appeals, quality of care) and conduct peer to peer discussions.
Provide appropriate mentoring and leadership to clinical teams as well as develop relationships to support growth and fiscal responsibility.
Devoted Health is dedicated to improving the health and well-being of older Americans by providing all-in-one healthcare solutions. Founded in 2017, they've rapidly expanded across the United States, fostering a diverse and collaborative work environment where employees are valued for their unique perspectives.
Responsible for quality assurance, accuracy and overall integrity of the UAS-NY assessment data and visit documentation completed by core team nurses as well as, business partners’ nurses.
Performing assessment audits, identifying trends that require staff retraining, and implementing corrective action plans in collaboration with Clinical management staff.
Responsible for ongoing orientation, training and education of Assessment Nurses conducting UAS-NY assessments, and participate in establishing educational modules for staff orientation and re-training.
Elderplan and HomeFirst are Medicare and Medicaid managed care health plans that are expanding services in response to patients' and members' needs. MJHS is a supportive community committed to excellence, respect, and providing high-quality, personalized health care services.