Provide utilization management services, transition of care, and support to members and health care providers.
Utilize clinical knowledge to interpret medical policy and provide consultation on UM requests.
Proactively assess and assist members through the continuum of care by utilizing services and resources efficiently.
Wellmark is a mutual insurance company owned by its policy holders across Iowa and South Dakota, and it has built its reputation on over 80 years of trust.
Work remotely to enhance member management and navigate the healthcare system.
Promote wellness and assist members in achieving their healthcare goals.
Conduct telephonic outreach, data analysis, clinical review, and documentation.
Guidehealth is a data-powered, performance-driven healthcare company dedicated to operational excellence, improving patient health, and restoring provider fulfillment.
Processes acute and post-acute inpatient medical or behavioral health and select intensive outpatient higher level of care requests through review of the submitted request and applicable clinical records
Collaborates with UM department staff, including Clinical Support Specialists and Medical Directors to make a final determination, and with Care Management staff on discharge planning and transition of care activities.
Identifies and refers members with complex needs to the appropriate population health and/or care management program.
Capital Blue Cross promises to go the extra mile for our team and our community. Our employees consistently vote us one of the “Best Places to Work in PA, and we foster a flexible environment where your health and wellbeing are prioritized.
Provide health assessments and treatment solutions via telephone, video, or chat functions.
Track and monitor follow-up calls, escalate when appropriate.
Receive inbound phone calls from patients seeking answers to various medical conditions.
PWNHealth is a national clinician network working to improve early detection and prevention of disease using advanced diagnostics and telehealth. They are a mission-driven, positive culture made up of the best and brightest in the industry.
Develop trusting long-term patient relationships and empower you to do the best work of your career. Conduct holistic assessments to identify conditions, functional status and member values. Support chronic disease management, using motivational interviewing techniques.
Devoted Medical was founded on the belief that if we treat each member like we would our loved ones, we can meaningfully improve healthcare experiences.