Analyze health plan reports and clinical data to identify members eligible for case management.
Conduct comprehensive telephonic and virtual assessments to evaluate medical, behavioral, and social needs.
Develop, implement, and monitor individualized care plans with measurable goals and interventions.
Duly Health and Care is a physician-led medical group offering a connected network of primary and specialty care, surgery centers, imaging, lab, and therapy services. They foster a collaborative culture centered on putting patients first and supporting team growth.
Manage care for high-risk members by identifying needs and coordinating clinical, community, and in-network resources.
Perform utilization management reviews, ensure quality oversight, and support accreditation readiness.
Collaborate with multidisciplinary teams to analyze member outcomes and drive continuous improvement.
They are a health plan focused on improving outcomes for high-risk members through care coordination and quality initiatives. Their team values collaboration, clinical excellence, and mission-driven work to enhance community health.
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.
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.
Coordinate and provide care that is timely, effective, and member-centric while following HMO processes.
Manage case assignments including outreach, documentation, monitoring for case progression, and case closure.
Assist members in reaching wellness by addressing barriers, social determinants, and psychosocial issues.
Guidehealth is a data-powered healthcare company dedicated to making great healthcare affordable and improving patient outcomes. It is a physician-led, performance-driven organization with a culture of empathy, accountability, and continuous learning.
Build meaningful relationships with patients and families to create personalized care plans addressing medical, behavioral, and social needs.
Coordinate care across providers and settings while educating and empowering members to navigate the healthcare system confidently.
Collaborate with an interdisciplinary team, using data for insight and maintaining compliance while prioritizing compassion and connection.
Guidehealth is a data-powered, performance-driven healthcare company using AI and predictive analytics to improve healthcare affordability and patient outcomes. It is a physician-led, fully remote organization with a collaborative, agile culture focused on innovation and empathy.
Coordinate and oversee collaborative patient care under physician direction, guiding patients through intake, diagnosis, treatment, and discharge.
Communicate with patients, physicians, and agencies to manage referrals, treatment plans, and pre-authorizations for desired clinical and financial outcomes.
Perform patient intake and discharge activities, including vital signs, room turnover, and documentation in accordance with hospital policy.
Virginia Mason Franciscan Health provides exceptional healthcare services, building on a legacy of compassionate care and innovation dating back to 1891. The organization employs a dedicated team across 10 hospitals and nearly 300 care sites, committed to healing the whole person and fostering a collaborative purpose.
Investigate workers’ compensation claims by interviewing injured workers, witnesses, and policyholders to verify coverage and determine compensability and benefits due.
Calculate and set timely financial reserves and proactively manage reserve adequacy throughout claim lifecycle.
Negotiate settlements of claims within designated authority with injured workers and attorneys.
BerkleyNet is an innovative workers compensation insurance provider that does all of its business online. Their goal is to make doing business 'Ridiculously Fast. Amazingly Easy.'
Conduct telephonic clinical assessments and health education using nursing process and protocols.
Utilize critical thinking to triage, make care recommendations, and document patient interactions.
Work a schedule including evenings and weekends, with full-time flexibility and remote setup.
Carenet Health provides clinical services and health education to patients through innovative telephonic channels. They are a growing organization with a collaborative team of registered nurses across the United States.
Coordinate and oversee patient care requests, ensuring timely and compassionate responses.
Serve as the central point of contact throughout the patient journey.
Maintain accurate electronic medical records and coordinate medical testing and follow-up care.
This company provides patient-centered healthcare coordination, connecting patients with physicians and specialists. They are a mission-driven organization that values collaboration, professional growth, and a supportive, inclusive workplace.
Authorizes and reviews utilization of mental health and substance abuse services in inpatient and outpatient settings.
Provides telephone triage, crisis intervention, and discharge planning while collaborating with clinical teams and providers.
Analyzes utilization data, participates in quality improvement projects, and advocates for patient treatment needs.
Magellan Health is a managed care organization focused on behavioral health and substance abuse services. They are a large employer with a culture centered on caring, professional growth, and employee wellbeing.
Oversee the Complex Clinical Bill Review team, managing production expectations, SLAs, client communication, and team performance.
Analyze and track internal business requirements, continuously evaluate functionality across programs, and perform requirements gathering to solve process issues.
Monitor team performance metrics, identify growth opportunities, and coordinate system enhancements including JIRA and UAT testing.
Machinify is a leading healthcare intelligence company providing an AI-powered platform for health plan clients. They are deployed by over 85 health plans, representing more than 270 million lives, with a culture of innovation and efficiency.
Provides comprehensive remote patient support and care coordination to optimize health outcomes in a virtual environment.
Collaborates with physicians and healthcare team members to assess patient status and develop personalized care plans.
Monitors patient progress, educates on disease processes, and advocates for patient needs to ensure high-quality care.
St. Joseph's Hospital and Medical Center is a 571-bed not-for-profit hospital in Phoenix, Arizona, offering quaternary care, medical education, and research. It is a nationally recognized center with over 125 years of history, consistently named an outstanding place to work.
Handle inbound and outbound patient calls for appointment scheduling, reminders, and follow-ups.
Document interactions accurately in electronic medical records to support continuity of care.
Coordinate with onsite healthcare personnel and healthcare teams using digital collaboration tools.
This company partners with U.S. healthcare clinics to provide remote clinical support. It offers a structured, service-focused environment with a team of nursing professionals.
Handle First Notice of Loss (FNOL) calls for auto and property insurance customers.
Gather, verify, and document claim information while explaining the claims process.
Provide empathetic, professional customer service in a high-volume remote environment.
Jobgether is an AI-powered job matching platform that connects candidates with hiring companies. The partner company fosters a supportive, collaborative culture with a focus on professional development and flexibility, though employee size is not specified.
Conduct detailed assessments and coordinate individualized care plans with healthcare teams.
Educate patients and families on disease processes, treatment options, and self-care strategies.
Advocate for patients' needs within the healthcare system, ensuring timely access to services.
Empowers individuals facing health challenges by providing compassionate, expert-guided care advocacy services. Dedicated to ensuring personalized support and seamless care coordination.
Coordinate patient onboarding, device setup, and education on remote monitoring technology.
Monitor patient data, analyze trends, and escalate health changes to providers.
Collaborate with healthcare professionals to optimize care and ensure documentation accuracy.
Optima Medical is an Arizona-based medical group providing personalized healthcare with a focus on preventing leading causes of death. With 30 locations and over 130 providers serving 200,000 patients, they offer a supportive and positive work environment.
Manage a caseload of post-payment Workers' Compensation bills, including disputes and negotiations.
Conduct proactive outreach to medical providers to resolve disputes and negotiate reductions.
Ensure compliance with state-specific regulations and maintain productivity standards.
Reliant Health Partners is an innovative medical claims repricing service provider that helps employers achieve maximum health plan savings with tailored services. The company values diversity and inclusion, fostering a collaborative environment as an equal opportunity employer.
Review patient information and medical histories to provide online patient care and education.
Participate in patient visits and answer questions through our telehealth platforms.
Follow established protocols and collaborate with the healthcare team, all conducted 100% remotely.
Florida Telehealth Medical Group is an innovative telemedicine company currently operating in 49 states. We treat tens of thousands of patients every month and are growing rapidly.
Provide short-term, telephonic care management to high-risk patients in the 30 days after hospital discharge, focusing on preventing avoidable readmissions.
Conduct comprehensive assessments, develop individualized care plans, educate patients and caregivers, and coordinate with interdisciplinary teams and community resources.
Serve as a patient advocate, helping navigate complex care journeys while working in a remote, metrics-driven environment.
Our partner is a healthcare organization that provides transitions of care support for high-risk patients post-hospital discharge. They operate in a collaborative, technology-enabled environment focused on measurable outcomes and exceptional patient experiences, and they are hiring for this role through Jobgether, an AI-powered job matching platform.