Act as a liaison for a patient panel of medically stable patients, coordinating care between internal and external providers.
Monitor and triage lab orders and results, providing education and medical management support to patients and families.
Triage emergent issues in a time-sensitive manner and coordinate care with hospitals for medical stabilization admissions.
Equip is the leading virtual, evidence-based eating disorder treatment program on a mission to ensure everyone with an eating disorder can access treatment that works. Founded in 2019, the company is fully virtual and has been recognized as one of the most influential companies of 2023, with a diverse and passionate team.
Provide timely, efficient, and accurate triage response and documentation according to nursing standards and physician protocols.
Evaluate patient needs, perform triage, and coordinate with the clinical team in an ambulatory practice setting.
Maintain accurate documentation in medical records, schedule patient visits, and provide education on patient care and health promotion.
Piedmont Healthcare is a healthcare provider offering services across Georgia. It is a large organization with a focus on patient care and corporate operations.
Perform case reviews and process requests for elective services and durable medical equipment.
Collaborate with physicians, vendors, and providers to ensure regulatory compliance and timely service.
Provide high-quality customer service to members and healthcare professionals.
Elderplan provides Medicare and Medicaid managed care health plans designed to help people stay independent. They are part of MJHS, a supportive community committed to excellence, respect, and collaboration.
Manage the member's clinical experience from request through desired outcome, including account activation and medical history drafting.
Coordinate video or phone consults with specialists and schedule monitors in advance, troubleshooting issues as needed.
Conduct ongoing follow-up post-consult and facilitate local recommendations, communicating with primary care physicians or specialists.
Transcarent is a health and care platform that combines medical, pharmacy, and point solutions with a generative AI-powered experience for health consumers. With over 1,700 employer and health plan clients serving 21 million Members, they foster a culture of People First, Care, Resilience, Results, and Humble and Human.
Provide patient information and education to ensure safe, effective, and appropriate use of Provenge from enrollment to completed infusions.
Collaborate with Patient Services, Sales Teams, and Medical Affairs to support patients and healthcare professionals.
Document all communications and conduct activities within legal and compliance guidelines, with potential field travel.
Dendreon is a biotechnology company focused on developing immunotherapy treatments for cancer, harnessing the power of the immune system to attack cancer cells. Headquartered in Seal Beach, California, with locations in Georgia and nationwide teams, they foster a purpose-driven, value-based culture putting patients first.
Lead end-to-end screening processes for a global pivotal trial, ensuring accurate and timely completion of pre-procedure assessments.
Collaborate with cardiologists, study coordinators, and field teams to evaluate patient eligibility and drive screening performance.
Ensure compliance with GCP, FDA, and trial protocols while managing screening data and identifying trends.
Anteris Technologies is a global structural heart company committed to revolutionizing cardiac care by pioneering biomimetic TAVR technology. With offices in the US, Switzerland, and Australia, we have a growing, inclusive team and a mission-driven culture focused on restoring healthy heart function for patients.
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.
Provide health care services regarding admissions, case management, discharge planning and utilization review.
Review admissions and service requests for medical necessity and reimbursement compliance.
Assess and coordinate discharge planning needs with healthcare team members.
UAB St. Vincent's, part of UAB Medicine, provides trusted healthcare in Alabama for over 125 years. With five hospitals and numerous clinics, the organization is guided by compassion and service, employing more than 4,800 people as one of Alabama's best hospitals.
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 training for staff members related to Utilization Review process, clinical guidelines, and workflows.
Creates educational material by collaborating with key resources to incorporate clinical scenarios.
Reviews monthly quality audit findings and provides one-on-one coaching to staff for performance improvement.
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 across four continents, operations in 13 countries, 65 delivery centers and more than 66,000 employees, the company combines scale, expertise and execution to create meaningful, measurable impact.