Source Job

• Provide medical review and clinical determinations based on evidence-based criteria for therapy programs.
• Support clinical content team in reviewing guidelines and literature, and conduct peer-to-peer discussions with providers.
• Demonstrate professionalism and accountability in a fast-paced, team-oriented environment.

Cohere Health provides a clinical intelligence platform and agentic AI-powered solutions that connect health plans and providers, optimizing care speed, cost, and quality. The company is rapidly scaling, backed by leading investors, and has been named to the Inc. 5000 list and a Top 5 LinkedIn Startup for 2023 & 2024.

• Provide medical management and utilization management decisions within scope of authority, ensuring compliance with regulations and client expectations.
• Conduct medical necessity reviews for rehabilitation services including physical therapy, occupational therapy, speech therapy, chiropractic, and acupuncture.
• Support delegated appeals processes, quality assurance, and telehealth consultation while collaborating with senior medical directors and clinical teams.

Our partner is a healthcare organization that provides physician-led clinical oversight across utilization management, medical necessity review, quality management, and virtual healthcare support. The company operates with a collaborative team of senior medical leadership and clinical staff, offering a remote work environment and part-time opportunities.

• Perform clinical reviews for medical necessity, level of care, and authorization compliance.
• Prepare and submit high-quality appeals related to DRG downgrades and clinical validation denials.
• Apply payer-specific guidelines and document review findings accurately in designated systems.

CorroHealth helps clients exceed their financial health goals through scalable revenue cycle solutions and clinical expertise. The company builds long-term careers by investing in team members' professional development and personal growth.

• Performs clinical evaluations on disability claims to substantiate medical necessity for absence.
• Communicates with employees and providers to discuss clinical status and provides follow-up recommendations.
• Acts as a clinical resource to claims examiners, ensuring accurate medical terminology and claim decisions.

Sedgwick is the world's leading risk and claims administration partner, helping clients navigate the unexpected with AI-enabled technology and expertise. With over 33,000 colleagues and 10,000 clients across 80 countries, they've been recognized as a Great Place to Work and offer a caring culture.

• Conduct medical necessity reviews for inpatient admissions and post-acute services using evidence-based guidelines.
• Lead peer-to-peer discussions with attending physicians to clarify clinical documentation and support appropriate care decisions.
• Collaborate with utilization management and care management teams to ensure consistent, cost-effective care.

Our partner company provides utilization management services for Medicare Advantage members, focusing on evidence-based clinical decision-making. It operates with a collaborative, matrixed team and emphasizes regulatory compliance and patient-centered care.

• Provide remote occupational therapy sessions and evaluations for a diverse pediatric population.
• Develop and implement care plans using Expressable's clinical tools and platform.
• Deliver outcomes-focused care with an emphasis on caregiver engagement and accurate documentation.

Expressable is an SLP-founded company on a mission to expand access to family-led online therapy. They have a team of 250+ clinicians and are backed by 3,500+ 5-star reviews, fostering a collaborative and supportive culture.

• Provide remote occupational therapy interventions to help patients achieve their functional goals.
• Educate patients and caregivers on techniques and strategies to enhance independence and well-being.
• Maintain accurate and up-to-date patient records, including progress notes and documentation.

All Care Therapies provides Physical, Occupational, Speech, and ABA therapy services virtually, in-home, and in clinics across California, Texas, and Nevada. We are a therapist-owned organization with a collaborative, patient-centered culture.

• Review medical records to develop concise clinical reviews supporting authorization and reimbursement.
• Facilitate communication with payors to ensure appropriate utilization management decisions.
• Collaborate with interdisciplinary team to prevent denials and optimize patient care.

West Virginia University Health System is West Virginia’s largest health system, providing comprehensive healthcare services. With over 35,000 employees and 25 hospitals, it is the state's largest employer and offers a collaborative, patient-centered culture.