Source Job

• Engage with members to support their chronic and/or complex health care needs.
• Create and manage individualized care plans to meet healthcare goals.
• Partner with members, families, providers, and resources to coordinate care.

Wellmark is a mutual insurance company owned by policy holders across Iowa and South Dakota, built on over 80 years of trust. They prioritize members' well-being and are committed to service, sustainability, and innovation.

• 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 telephonic assessments of members’ medical, psychosocial, physical, and spiritual needs.
• Develops a Person-Centered Service Plan (PCSP) utilizing UAS-NY assessments.
• Revises the PCSP and communicates changes with interdisciplinary care team and PCP in response to changes in members’ condition.

MJHS provides high-quality, personalized health care services. At MJHS, they foster collaboration, celebrate achievements, and promote fairness.

• You will be responsible for using your assessment and communication skills to engage with patients in need of clinical support to determine and prioritize their needs.
• Conduct timely telephonic clinical outreach to identified patients.
• Collaborate with PCPs, NPs, and other members of the healthcare team to coordinate care for patients and actively help keep them stable at home.

Vytalize Health is building a market leader in value-based healthcare. They are a rapidly growing organization that embraces the power of AI and encourages innovative, responsible use of emerging technologies in their work.

• 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.

• Work remotely to enhance member management and maximize cost effectiveness.
• Collaborate with clients and members to promote wellness and assist in achieving health goals.
• Collect data, conduct clinical reviews, and ensure documentation complies with regulations.

Guidehealth is a data-powered healthcare company dedicated to operational excellence. They aim to make healthcare affordable and improve patient health, employing remotely-embedded Healthguides™ and a Managed Service Organization to build stronger connections with patients and providers.

• Provides telephonic assessments of members’ medical, psychosocial, physical and spiritual needs.
• Develops, implements, and monitors person centered service plan and ensures continuity of care across all healthcare settings.
• Educates members on disease processes, preventative health, and quality of life interventions.

MJHS is a supportive community committed to excellence, respect, and providing high-quality, personalized health care services. They foster collaboration, celebrate achievements, and promote fairness for all with comprehensive compensation and benefits.

• Manage multiple channel interactions professionally and efficiently.
• Effectively present products/services to providers with integrity, understanding, and accuracy.
• Focus on provider retention through first call resolution and maintain positive relationships.

Capital Blue Cross promises to go the extra mile for its team and community. Employees consistently vote it one of the “Best Places to Work in PA”, valuing professional/personal growth by investing heavily in training and continuing education.

• Build meaningful relationships with patients and families, understanding their goals, barriers, and motivators.
• Creating personalized care plans that go beyond diagnoses, addressing social determinants, emotional well-being, and behavioral health when applicable.
• Coordinate care across providers and settings, ensuring safety, quality, and continuity.

Guidehealth is a data-powered, performance-driven healthcare company dedicated to operational excellence. Our goal is to make great healthcare affordable, improve the health of patients, and restore the fulfillment of practicing medicine for providers.

• Working with a team of Intake Coordinators and Utilization Review Nurses to ensure quality and timely determinations.
• Striving for continuous improvement and an excellent work-life balance to produce top-notch results.
• Coordinating and providing care management that is timely, effective, efficient, equitable, safe, and member centered.

Guidehealth is a data-powered, performance-driven healthcare company dedicated to operational excellence. Our goal is to make great healthcare affordable, improve the health of patients, and restore the fulfillment of practicing medicine for providers.

• Deliver coordinated, patient-centered virtual Care Management by telephone or video that improves members' health outcomes.
• Create impactful care plans together with members and our diverse care team, helping members achieve their desired goals.
• Help members navigate complex medical conditions, treatment pathways, benefits, and the healthcare system in general.

Jobgether uses an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. They identify the top-fitting candidates, and this shortlist is then shared directly with the hiring company.

• Outbound calls, calling members to inform them of their Specialist Management Solutions benefits and act as a care guide on behalf of the customer helping them receive treatment from a network of high-quality surgeons
• Receive inbound calls from members to educate them on their Specialist Management Solutions benefits and provide guidance with appointment scheduling
• Assist in the coordination of care across a variety of settings, while maintaining strict confidentiality and the highest level of professionalism

Lantern is a specialty care platform connecting people with the best care when they need it most. They curate a Network of Excellence comprised of the nation’s top specialists for surgery, cancer care, infusions and more, delivering excellent care with significant cost savings to employers and their workforces.

• Answers first level calls in Utilization Review.
• Evaluates certification requests by reviewing group specific requirements.
• Triage the call to determine if a Utilization Review Nurse is needed.

Cottingham & Butler sells a promise to help clients through life’s toughest moments by hiring, training, and growing the best professionals. The company culture is guided by the theme of “better every day” constantly pushing themselves to be better than yesterday.

• Coordinates home infusion services for compliance.
• Organizes, plans, and evaluates agency services and programs.
• Ensures effective delivery of services to maintain quality care.

BioMatrix is a nationwide, independently-owned infusion pharmacy with decades of experience supporting patients on specialty medication. Their compassionate care team helps patients navigate the often-challenging healthcare environment and treats their patients like family.

• Take inbound calls from patients, providers and members
• Support members with their insurance needs, questions or concerns
• Answer inquiries on benefit claims, appeals, and authorizations

Carenet Health pioneers advancements for an experience that touches all points across the healthcare consumer journey. They interact with 1 in 3 Americans every day, delivering positive healthcare experiences and improving outcomes.

• Conduct coverage reviews based on member plan benefits and policies.
• Document clinical review findings, actions, and outcomes.
• Communicate and collaborate with providers for benefit determinations.

Capital Blue Cross promises to go the extra mile for their team and community. They foster a flexible environment where health and wellbeing are prioritized and employees consistently vote it as one of the "Best Places to Work in PA."

• 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.

• 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.

• Develop trusting relationships with patients, grounded in listening, respect, and clarity.
• Assess the whole person — medical, social, and environmental factors — to pinpoint barriers and needs.
• Create individualized care plans that integrate medical, social, and behavioral supports.

Baba makes navigating health, aging, and loneliness easier by pairing each patient with a real human advocate team that supports them between visits. Baba is backed by top tier investors and supports thousands of families across assisted living, nursing homes, and at-home settings.

• Manage a defined caseload of enrolled CCM members.
• Identify and address social determinants of health, including food access, housing resources, transportation, and community supports.
• Partner closely with the RN and NP to surface barriers impacting care or engagement.

Pair Team is a tech-enabled medical group delivering whole-person care - clinical, behavioral, and social - by partnering with organizations deeply connected to the communities they serve. They're building a care model that empowers clinicians and care teams to do what they do best: provide compassionate, high-impact care.