Assess, plan, implement, and coordinate comprehensive care plans to meet individual health needs and ensure cost-effective healthcare delivery.
Serve as a liaison facilitating collaboration among patients, families, physicians, and providers to promote quality of care.
Provide specialized education on disease-specific conditions and remain current with medical trends and procedures.
Arkansas Blue Cross and Blue Shield is a health insurance company providing healthcare coverage and services. They are consistently ranked as a top workplace in Central Arkansas with an inclusive culture and average employee tenure of 10 years.
Provide telephonic case management and utilization review for assigned consumers.
Develop, implement, and monitor individualized care plans to ensure quality and cost-effective outcomes.
Collaborate with healthcare providers, payors, and internal teams to coordinate care.
Cottingham & Butler helps clients through life's toughest moments by providing insurance and benefits solutions. The company fosters a culture of continuous improvement, seeking to hire, train, and grow the best professionals in the industry.
Identify, research, process, and resolve customer inquiries regarding health insurance benefits, claims, and eligibility.
Analyze medical records and apply medical necessity criteria to determine the appropriateness of benefit requests.
Maintain accurate records, meet quality and timeliness standards, and coordinate with internal departments and external organizations.
Blue Cross Blue Shield of Arizona provides health insurance products and services to individuals, families, and businesses, aiming to inspire health and make it easy. The company has been recognized as a Healthiest Employer and has transformed healthcare for over 80 years with teams in Phoenix, Tucson, Chandler, and Flagstaff.
Provide exceptional customer service and build rapport with patients.
Serve as the new patient scheduling liaison for 16 clinics and telehealth visits across 20+ states.
Manage and schedule new patient appointments and promptly respond to patient inquiries.
Aligned Modern Health is changing the face of healthcare with a holistic, multi-disciplinary model offering evidence-based solutions. The company has 16 clinics across Chicago and suburbs, provides telehealth services in over 20 states, and prides itself on outstanding clinical outcomes and a five-star patient experience.
Provide comprehensive case management services including assessing client needs, developing care plans, coordinating services, and monitoring progress.
Collaborate with healthcare professionals, insurance companies, and stakeholders to ensure seamless care coordination and favorable outcomes.
Maintain accurate documentation, educate clients and families on self-management, and stay current with industry best practices.
MVP Health Care is a not-for-profit health plan provider focused on creating a healthier future through innovation and equity. For over 40 years, they have served New York and Vermont communities with high-quality health plans and have been recognized as a Best Place to Work.
Answer inbound calls and make outbound calls to participants enrolled in the Condition Management Program.
Assist participants via email and online messaging, and accurately document all participant communications.
Work independently and in a team environment with strong customer service skills; no experience required as training is provided.
Cottingham and Butler's Health and Wellness division focuses on reducing medical costs while increasing employee engagement and productivity through onsite screenings, technology, and condition management programs. They value an open-door culture where team opinions are appreciated.
Complete biopsychosocial assessments to identify clinical, behavioral, and social needs.
Proactively identify and resolve care gaps in patient records, ensuring timely clinician review.
Coordinate referrals, follow-up appointments, and community-based care support services.
Knownwell provides weight-inclusive healthcare for all, offering weight management, primary care, nutrition counseling, and health coaching. They are backed by $50M in funding, scaling fast to expand access to evidence-based obesity care nationwide.
Build trusting relationships with patients and providers to address health barriers and coordinate care.
Navigate medical, behavioral, and social systems to connect patients with appropriate resources.
Support value-based care outcomes through proactive outreach, documentation, and quality measures.
Guidehealth is a data-powered, performance-driven healthcare company dedicated to operational excellence. As a growing and innovative organization, we operate with a high degree of agility.
Implements and supports the philosophy, mission, values, standards, policies, and procedures of The Ohio State University Wexner Medical Center.
Functions within the multidisciplinary team to secure complex pre-authorizations and prevent/appeal clinical denials.
Utilizes clinical knowledge to interpret and apply medical necessity guidelines to determine appropriateness for services provided.
The Ohio State University is a top-20 public university with one of America’s leading academic health centers. They are a team of dedicated colleagues with access to boundless resources.
Provide telephone support to patients, healthcare professionals, and funding organizations regarding access, reimbursement, compliance, and support programs.
Manage assigned patient cases and projects while following established operational processes and service standards.
Maintain accurate case documentation within program databases, ensuring all activities and interactions are properly recorded.
This role is posted on behalf of a partner company, which manages all applications and next steps. The company focuses on healthcare support and improving patient access to therapies, with a collaborative culture and opportunities for professional growth.
Handle incoming calls in a fast-paced call center environment, assisting members with benefits, eligibility, and claims inquiries.
Maintain composure and positivity while de-escalating challenging situations and managing relationships with members.
Apply standard operating procedures and recommend process improvements for a better member experience.
Blue Cross and Blue Shield of Minnesota is a nonprofit health insurance company committed to transforming healthcare. It is one of the most recognized healthcare brands in Minnesota with a large network of doctors and a culture based on collaboration and integrity.
Responsible for using assessment and communication skills to engage patients in need of clinical support, determine priorities, and deliver patient-centered care.
Identify patient education needs through telephonic assessment and collaborate with healthcare teams to coordinate care and keep patients stable at home.
Serve as point of contact for patients, families, and providers, implementing interventions to improve health outcomes and reduce costs.
Vytalize Health is a value-based healthcare company that coordinates care for patients with chronic conditions, aiming to improve outcomes and lower costs. It is a rapidly growing organization with a startup culture, offering a dynamic environment.
Coordinate care for adolescent and young adult patients, including outreach, chart scrubbing, and panel management.
Provide medical assistant duties and support the care team with referrals, follow-ups, and documentation.
Communicate with patients and families via phone, MyChart, and email to ensure compliance and care coordination.
Oregon Health & Science University is a public academic health center in Portland, Oregon, providing patient care, groundbreaking research, and training for healthcare professionals. It is the largest employer in Portland, operating hospitals and clinics across Oregon and Southwest Washington, and is committed to being an anti-racist, multicultural institution.
Review and verify insurance coverage, obtain authorizations, and create patient liability estimates while working closely with internal and external stakeholders.
Serve as a liaison between patients, providers, and insurance companies to ensure accurate financial services and resolve managed care issues.
Provide backup support and cross-coverage for the Centralized Managed Care & Price Estimates Department, including handling trauma admissions and third-party liability.
OHSU is Oregon's only public academic health center, providing patient care, leading groundbreaking research, and training the next generation of healthcare professionals. As Portland's largest employer, it offers a diverse and inclusive culture with opportunities for growth and advancement.
Act as the primary point of contact for patients, healthcare providers, and program stakeholders.
Manage patient access, reimbursement, and therapy support processes.
Build trusted relationships with healthcare professionals and ensure coordinated care.
A healthcare services organization that partners with patients and providers to navigate complex treatment processes. The culture is purpose-driven, collaborative, and inclusive, with an emphasis on improving health outcomes.
Act as a vital link between clients and clinicians, managing schedules, rescheduling appointments, and optimizing efficiency.
Serve as the first point of contact for client inquiries via phone, text, and email, providing timely and compassionate support.
Support clinicians with updates and client preferences to ensure seamless care delivery and foster a supportive experience.
Headlight is a mental healthcare company founded by psychiatrists that transforms access to care and delivery methods. As the most trusted behavioral health partner in the Western U.S., it operates with a collaborative culture and a focus on improving patient outcomes.
Assess, identify, and resolve dental provider inquiries regarding claims, eligibility, and benefits via phone in a timely and professional manner.
Research and handle complex requests, manage personal inventory, and ensure effective follow-up to meet quality and business metrics.
Communicate clearly with providers, peers, and leadership, and contribute to divisional and corporate goals while fostering a team-based environment.
Blue Cross Blue Shield of Massachusetts is a community-focused, tax-paying, not-for-profit health plan headquartered in Boston, serving 2.8 million members for over 75 years. We are consistently ranked among the nation's best health plans and are dedicated to creating an inclusive, wellness-focused culture that promotes work-life balance.
Schedule, confirm, and manage appointments for benefit counselors, coordinating daily schedules to maximize efficiency and accommodate client needs.
Provide outstanding customer service by assisting clients with scheduling questions and general benefit enrollment information, maintaining accurate records.
Support the benefit team with administrative tasks including data entry, report preparation, and rescheduling appointments as needed.
Hilb Group is a Top 25 middle-market independent insurance broker offering expertise in property & casualty, employee benefits, HR consulting, and retirement services nationwide. The firm provides the resources of a big broker with the personal service of a small agency, driven by values of trust, passion, integrity, and growth.
Perform clinical reviews and conduct peer-to-peer discussions.
Participate in inter-rater reliability activities and clinical rounds.
Serve as a clinical resource and subject matter expert to clinical and non-clinical staff.
Devoted Health is a healthcare company that aims to improve the health and well-being of older Americans through a data and AI-driven care platform. The company values diversity, collaboration, and a supportive work environment, and is an equal opportunity employer.
Conduct telephonic outreach to Medicare members to improve medication adherence and HEDIS diabetes and blood pressure control.
Use motivational interviewing to assess health risks and engage members in behavior change.
Partner with members to identify opportunities for integration into internal/external programs and coordinate care.
CVS Health is building a world of health around every individual, shaping a more connected, convenient and compassionate health experience. They are a large company with passionate colleagues who care deeply, innovate with purpose, and prioritize safety and quality.