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.
You will serve as a critical liaison between patients, providers, care teams, and community resources to ensure continuity of care.
You will create and promote adherence to treatment plans developed by healthcare providers.
You will assess patients' unmet health and social needs and connect them to relevant community resources.
Point C is a national third-party administrator that delivers customized self-funded benefit programs. We are a mission-driven company focused on innovative cost containment strategies and driving down plan costs.
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.
Provides active care management and coordinates action plans for members.
Evaluates outcomes and ensures accurate documentation of clinical information.
Serves as member advocate and promotes enrollment in care management programs.
BlueCross BlueShield of South Carolina is a leading health insurance company and administrator of government contracts. With an A+ rating and a diverse family of subsidiaries, they are the largest insurer in South Carolina and employ a dedicated team focused on outstanding customer service.
Coordinate patient identification and care planning for the Remote Care Management program, including attending inpatient rounds and reviewing charts.
Support program expansion by teaching and promoting RCM to primary care providers and community partners through virtual and in-person formats.
Track referrals, validate program data, and assist in developing new RCM pathways through collaboration with internal and external teams.
Halton Healthcare provides quality, compassionate healthcare services to rapidly growing communities in Ontario. As a progressive and vibrant organization, they are committed to being an innovative center of excellence in community hospital care, with a culture focused on exemplary patient and staff experiences.
Assess and coordinate care for members, ensuring continuity and person-centered service plans.
Manage a caseload of 20-30 calls per day, including crisis calls, and lead interdisciplinary care teams.
Coach and mentor less experienced Care Managers to support team development.
Integrated Resources, Inc. is a workforce solutions company that delivers strategic talent management services. Founded in 1996, the company has grown steadily and focuses on matching qualified professionals with employers, building long-term partnerships based on performance and integrity.
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.
Coordinate comprehensive, person-centered care for clients with complex needs, partnering with healthcare providers and social services.
Assess member needs across physical health, mental health, social supports, and more, and oversee development of care plans.
Utilize evidence-based practices like Motivational Interviewing and Trauma-Informed Care to empower clients and promote wellness.
Vynca provides comprehensive care for individuals with complex needs, with a mission to enable more quality days at home. They describe themselves as a close-knit community guided by core values of Excellence, Compassion, Curiosity, and Integrity.
Manage a portfolio of clients, providing clinical support, education, advocacy, and care coordination throughout their healthcare journey.
Conduct clinical intakes, collaborate with internal teams, and ensure smooth transitions across care delivery.
Communicate clearly and compassionately with clients, caregivers, providers, and internal partners.
Private Health Management guides patients and families through serious medical care, acting as an independent advocate to orchestrate the best treatment and support. The company is a mission-driven organization with a team of experts that provides compassionate, high-quality care coordination.
Provide telephonic case management to proactively drive return to work.
Perform utilization review and coordinate care with providers and adjusters.
Evaluate treatment plans and partner with adjusters to achieve optimal outcomes.
AmTrust Financial Services is a fast-growing commercial insurance company providing comprehensive telephonic case management. They foster a diverse and inclusive culture with a focus on attracting and retaining the best talent.
Develop and coordinate individualized treatment plans and discharge services for patients.
Perform medical record reviews to assess admission appropriateness and ensure compliance with standards.
Support denials management and appeals for insurance claims to ensure quality care.
Northwestern Medicine is a healthcare system focused on patient-first care. We offer a supportive workplace with competitive benefits and a culture of growth.
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.
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.
Engage with members by phone to encourage participation in care management programs and complete non-clinical assessments.
Identify barriers to care and connect members with appropriate services, benefits, and community resources.
Accurately document member interactions and operate effectively in a high-volume, remote call-center environment.
This partner company helps members navigate care management programs and access resources to improve their health and well-being. It operates remotely with a focus on compassionate support and efficient operations, though specific size and culture details are not mentioned.
Strategically assess, plan, and facilitate comprehensive care across the continuum for high-risk patients.
Collaborate with physicians, nursing, insurers, and post-acute providers to ensure timely transitions.
Work remotely from California, using provided equipment, with potential weekend/holiday coverage.
Dignity Health Management Services provides integrated managed care administrative and clinical services to medical groups, hospitals, and health plans. It is part of CommonSpirit Health, one of the largest nonprofit health systems in the US, with a focus on coordinated patient care and community health.
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.
Monitor and interpret patient vitals, assessments, and alerts within Welby Health’s platform to provide timely, evidence-based guidance and escalate clinically significant findings.
Develop, implement, and adjust individualized care plans addressing both clinical and social needs, coordinating with physicians, specialists, and community resources.
Deliver patient education and coaching via telephone and secure messaging, empowering patients to manage chronic conditions and build sustainable health habits.
Welby Health is a San Diego-based healthcare organization committed to transforming the way complex conditions are managed. The company leverages technology and clinical expertise to improve patient outcomes and practice efficiency.
Set daily direction for your UM team, establishing priorities and reinforcing expectations.
Coach reviewers on criteria application, guiding consistent use of medical-necessity criteria.
Monitor workflow health daily, tracking intake volume and turnaround risk.
Personify Health created the first and only personalized health platform, bringing health plan administration, holistic wellbeing solutions, and comprehensive care navigation together. The team is on a mission to empower people to lead healthier lives.
Perform prospective, concurrent, and retrospective utilization reviews for behavioral health services across multiple care settings.
Assess medical necessity and coordinate care with providers, members, and internal teams to ensure appropriate access and treatment.
Support discharge planning, benefit utilization, and regulatory compliance while improving overall care quality.
This company provides high-quality behavioral health coordination and utilization management services to improve member outcomes. They foster a supportive, collaborative environment focused on professional growth and clinical excellence.
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.