Performs utilization review to determine medical necessity criteria compliance and facilitates resolution of escalated cases.
Collaborates with clients and physician reviewers, ensuring adherence to all HIPAA, state, federal, and regulatory standards like URAC & NCQA.
Utilizes various computer systems to manage cases, engages in provider communication, and participates in quality management programs while prioritizing independent work.
WNS, part of Capgemini, is an AI-powered leader in intelligent operations and transformation, serving over 700 clients across industries like Healthcare and Financial Services. It is a large global company with over 66,000 employees, combining deep domain expertise with AI platforms to create lasting business value.
Provides nursing assessments within the standards outlined in the state Nurse Practice Act.
Provides clinical assessments and health education using telecommunications in accordance with protocols and guidelines.
Uses the nursing process to identify patient care needs, risk and safety issues, and appropriate health care referrals.
Carenet Health delivers patient-centric healthcare solutions. We foster a collaborative team of RNs across the country and are committed to creating an inclusive environment for all employees.
Drive quality, safety, and compliance through systems by identifying issues and implementing process improvements.
Execute order management and EMR workflows by reviewing and approving new orders and supporting clinical escalations.
Manage end-of-episode processes, hospital holds, and monitor patient status and quality compliance through dashboards and alerts.
They are building an AI-native physical care platform to fix US healthcare, starting with home health. The company has assembled a team of AI experts from leading firms and paired them with healthcare veterans to operate at the speed of an AI company.
Provide exceptional care, disease management and health education to patients.
Support goal setting for individual patients asynchronously to help them better manage their chronic conditions.
Create personalized action plans with guidelines to reduce or eliminate unwanted behaviors.
Salvo Health is a new approach to help millions of Americans facing chronic health conditions, centered on chronic gut health and metabolic conditions from IBS to obesity. They bring multidisciplinary virtual care to patients at community specialty care practices. Salvo offers a competitive salary and health benefits, a remote work environment, flexible time-off, a larger sense of mission, and professional development and entrepreneurial opportunities.
Providing remote health coaching to members at risk for chronic kidney disease or have chronic kidney disease.
Working in partnership with participating members to increase their understanding and management of conditions that impact kidney health.
Establishing and maintaining contact with assigned and active members via video, phone, text, and email.
Renalogic is dedicated to helping clients manage the human and financial costs of chronic kidney disease. They hire people who are humble, hungry, and smart, and they have a 96% client retention rate.
Nurse conducts clinical review of cases not meeting criteria by performing clinical intake.
Adjudicates (closes), requests additional clinical information or escalates to Medical Directors.
Active PRC and USRN License required with 2 years Bedside Experience.
WNS, part of Capgemini, is an Agentic AI-powered leader in intelligent operations and transformation, serving more than 700 clients across 10 industries. With 66,000 employees, WNS combines scale, expertise and execution to create meaningful, measurable impact.
Provide high-quality virtual primary care through video visits, including assessment, diagnosis, treatment, and patient education.
Manage a panel of patients, delivering comprehensive care across acute, chronic, and preventive needs.
Collaborate with the Care and Case Management team to develop care plans and support successful outcomes.
Included Health delivers integrated virtual care and navigation, aiming to raise the standard of healthcare for everyone. The company breaks down barriers to provide high-quality care for every person, offering care guidance, advocacy, and access to personalized virtual and in-person care.
Conduct IOP orientations for new patients, introducing program structure, expectations, and resources.
Lead discharge planning beginning at admission, ensuring linkage to outpatient providers, community resources, and payor-approved step-down services.
Track engagement, discharge, and readmission metrics; report trends to the Clinic IOP Director for quality-improvement initiatives.
Salma Health is reimagining brain healthcare by bringing together advanced diagnostics, evidence-based treatments, and continuous support under one connected system. Their multidisciplinary team delivers personalized care for people living with brain and mental health conditions.
Conduct new patient visits via telemedicine, focusing on chronic condition management.\n- Collaborate with RNs to develop individualized care plans tailored to patients' needs.\n- Perform telemedicine visits for ailments experienced by residents in senior living communities.
Red Cell Partners is an incubation firm building and investing in rapidly scalable technology-led companies that are bringing revolutionary advancements to market in healthcare, cyber, and national security. United by a shared sense of duty and deep belief in the power of innovation, Red Cell is developing powerful tools and solutions to address our Nation’s most pressing problems.
Evaluates member health metrics and professional resources to inform UM/CM initiatives and programs.
Refers members and providers to G.E.H.A resources and programs, as indicated, maximizing their health plan benefits.
Monitors and evaluates program effectiveness, tracks relevant metrics, and reports outcomes.
Government Employees Health Association (G.E.H.A) is a nonprofit member association providing health and dental benefits to millions of federal employees and retirees since 1937. G.E.H.A is headquartered in Lee's Summit, Missouri, offering hybrid and work-from-home options for many roles.
Communicate and provide education to members and providers on insurance plan benefits and digital health solutions.
Employ active listening & motivational interviewing skills, and can handle difficult calls tactfully, courteously, professionally and document accordingly that can build patient trust and engagement.
Accurately track and document work on a variety of internal software tools and platforms.
Evry Health is on a mission to bring humanity to health insurance. They are a high-technology health plan that expands benefits, increases access and transparency, and features a personalized, human approach. Evry Health is the major medical division of Globe Life (NYSE:GL) with more than 3,000 corporate employees and 15,000 agents.
Provide empathetic, non-judgmental care while maintaining clear emotional boundaries
Accurately document consult outcomes to support safe and effective prescribing
Montu is Australia's largest healthtech business focusing on alternative healthcare. Founded in 2019, it supports patients, doctors, and pharmacies, and is known for its rapid growth and being named #1 on LinkedIn’s Top Startups Australia 2024.
Provide empathetic, non-judgmental care while maintaining clear emotional boundaries
Accurately document consult outcomes to support safe and effective prescribing
Montu is Australia's largest healthtech business with a focus on alternative healthcare. Founded in 2019, it supports patients, doctors and pharmacies through its Alternaleaf clinic, offers accredited healthcare education to clinicians via its SAGED platform and dispensing solutions to pharmacies across Australia through Leafio.
Provide health assessments and treatment solutions via telephone, video, or chat functions.
Receive inbound phone calls from patients seeking answers to various medical conditions.
Stay up to date with current health trends and recommendations.
PWNHealth is a national clinician network improving early disease detection and prevention using advanced diagnostics and telehealth, serving all 50 states and Puerto Rico. They are a mission-driven company with a positive culture, backed by leading growth equity firms Spectrum Equity and the Blue Venture Fund (BVF).
Coordinate medical record retrieval, ensuring complete and timely submission of patient documentation for provider review
Prepare and process referrals to specialists and manage prior authorization requests in coordination with insurance payors
Virtually greet and room patients prior to telehealth appointments, confirming patient information and visit readiness
Synapticure is a patient and caregiver-founded company that provides instant access to expert neurologists, cutting-edge treatments and trials, and wraparound care coordination and behavioral health support in all 50 states through a virtual care platform. They are dedicated to transforming the lives of millions of individuals and their families living with neurodegenerative diseases like Alzheimer’s, Parkinson’s, and ALS.
Manage day-to-day credentialing and re-credentialing workflows for Tia’s provider network.
Support medical licensing workflows for MDs, DOs, NPs, PAs, and RNs across multiple states, including tracking requirements, deadlines and renewals.
Track onboarding progress and help ensure providers are licensed, credentialed, enrolled, and compliant before go-live.
Tia is building a new model for women’s healthcare, one that treats women as whole people. They are a Series D, venture-backed company trusted by more than 120,000 women across four markets, building a culture of excellence in people, process, and product.
Lead the day-to-day operations of a remote team of RNs and LPNs responsible for reviewing and resolving real-time patient alerts.
Conduct clinical audits and chart reviews to evaluate triage quality, documentation accuracy, and adherence to care protocols.
Provide structured coaching, real-time feedback, and formal performance management to improve both clinical judgment and productivity.
Cadence is a clinical AI company that delivers continuous, proactive care for older adults with chronic conditions. They pair patients with a dedicated clinical team and integrate deeply into health system EMRs and workflows. Cadence operates as a full clinical care delivery organization.
Conducting virtual assessments, diagnoses, and evidence-based treatment for patients.
Managing and coordinating care for chronic conditions.
Providing preventive care, wellness counseling, and health education.
Curai Health aims to transform healthcare using AI and clinical expertise to make care more affordable and accessible. They are a mission-driven team committed to collaboration and driving meaningful impact in healthcare.
Manage patients through virtual encounters, reviewing vital signs and symptoms to drive treatment adjustments.
Conduct clinical audits and implement quality improvement strategies to improve patient outcomes.
Coach and develop a team of Nurse Practitioners through feedback and clinical education.
Cadence Health delivers proactive care to seniors by extending the reach of primary care providers. Their technology and clinical care team support patients every day at home, partnering with leading health systems to monitor patients and improve outcomes.
Provide video-based comprehensive clinical care, including acute care, pediatrics, and mental health.
Work weekend day shifts and one weekday, totaling 36 hours per week, with Epic EMR management responsibilities.
Collaborate with a care team, educate patients, prescribe medications, and focus on patient outcomes while reducing administrative burden.
K Health is an AI-powered virtual care company that partners with leading health systems to build and run modern primary virtual care clinics. Founded in 2016 and headquartered in New York City, it is a well-funded startup with a diverse, inclusive culture focused on putting humans first and closing care gaps.