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.
Evaluates hospital records for diagnostic coding accuracy and clinical documentation alignment.
Conducts DRG validation, readmission, and level-of-care reviews using evidence-based guidelines.
Produces clear clinical summaries and supports utilization management and peer review activities.
The company provides medical record review and utilization management services to ensure accurate coding and appropriate reimbursement. It is a remote-first organization with a focus on clinical integrity and quality assurance.
Provide clinical leadership and medical oversight for audit programs involving governmental and commercial payer claims.
Evaluate medical necessity, level of care, coding accuracy, and documentation sufficiency using payer policies and clinical standards.
Support audit methodologies, clinical validation frameworks, and quality assurance to ensure regulatory alignment and defensibility.
Machinify is a leading healthcare intelligence company delivering value, transparency, and efficiency to health plan clients. Deployed by over 85 health plans representing more than 270 million lives, they bring an AI-powered platform alongside best-in-class expertise.
Perform clinical reviews for medical necessity, level of care, and authorization-related denials.
Review inpatient and outpatient medical records to support appeal submissions and apply payer-specific guidelines.
Document review findings accurately and meet assigned turnaround times while maintaining quality standards.
CorroHealth helps clients exceed their financial health goals by providing scalable solutions and clinical expertise across the reimbursement cycle. The company fosters a supportive culture that invests in professional development and personal growth.
Lead medical work across sponsor-direct trials, including encoding new trials, iterating screening rules with engineering, and supervising a small medical contractor team.
Perform hands-on EMR review and clinical reasoning while setting strategic medical direction and contributing to customer and business conversations.
Partner with engineering to refine automated EMR screening, defining clinical logic for patient exclusion and human review, and contribute to product and trial design.
HealthMatch is on a mission to advance medicine by connecting patients with clinical trials. With over 2 million patients in our database and a growing trial portfolio, we are closing the gap in trial recruitment through technology and patient engagement.
Lead clinical programming and quality initiatives, including Stars/HEDIS strategy and risk coding documentation improvement.
Collaborate with Product, Engineering, and Analytics to design AI-enabled clinical tools and workflows.
Drive data-driven outcomes by monitoring metrics and identifying opportunities for intervention and improvement.
Chamber Cardio rebuilds the cardiology system by partnering with independent cardiologists to improve population health through technology, data, and operational tools. They are a mission-driven organization focused on innovation and empathy, blending clinical expertise with modern operating platforms.
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.
Own first-level reviews of pre-certification requests for medical appropriateness and necessity.
Drive post-service reviews and manage the appeals process for non-certified services.
Coordinate smooth discharges and redirect care in-network to keep patients on track.
Personify Health created the first personalized health platform, bringing health plan administration, wellbeing solutions, and care navigation together in one place. Their team serves employers, health plans, and health systems with a mission to empower people to lead healthier lives.
Review medical records within 24-48 hours of admission to evaluate documentation for accurate DRG assignment, severity of illness, and risk of mortality.
Conduct follow-up reviews every 2-3 days and formulate compliant provider queries regarding missing or conflicting documentation.
Educate patient care team members on documentation guidelines and collaborate with HIM coding professionals to ensure accuracy and integrity.
CommonSpirit Health is a large nonprofit Catholic healthcare organization delivering integrated health services. It has over 157,000 employees and 45,000 nurses across 24 states.
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.
Perform medical necessity reviews of clinical documentation to determine appropriateness of inpatient and outpatient services.
Develop relationships with medical providers and health plans to confirm adherence to policies and guidelines.
Stay updated on technology changes, regulatory issues, and medical practices through ongoing training.
Trend Health Partners is a tech-enabled payment integrity company that facilitates collaboration between payers and providers to reduce waste and improve healthcare access. It promotes a collaborative and innovative work environment as a dynamic, growing organization.
Serve as primary liaison between Network Performance and specialist providers, driving data-driven performance improvements.
Develop and maintain trusted relationships with specialists to improve network quality and efficiency.
Lead data-driven discussions on utilization trends and referral patterns to achieve cost savings.
Clover Health provides high-quality, affordable healthcare plans for seniors using data and technology. They are a mission-driven team with diverse expertise, committed to improving healthcare through innovation and inclusivity.
Guide medical students and physicians through residency planning, board certification, and licensing requirements.
Support career development including resume review, interview prep, salary negotiation, and networking strategy.
Set your own hours and rates, host sessions virtually, and partner with our team to deliver a high-quality, supportive experience.
Leland is building the home for ambition in the age of AI, connecting people with the experts, programs, and communities they need to land the job, get into the school, or upskill for a world being rewritten by AI. Since our founding in 2021, we've helped tens of thousands of people reach their most ambitious goals and raised $19M from world-class investors, operating in a collaborative, high-energy, AI-native environment.
Ensure acute hospital admissions have appropriate level of care and meet medical necessity.
Monitor patient progress in plan of care for continued stay.
Provide clinical information to payer to authorize acute hospital stay and continued services.
Piedmont Healthcare is a healthcare organization focused on patient outcomes. It offers a supportive culture with diverse teams, schedule flexibility, and comprehensive benefits, fostering employee growth and well-being.
Facilitate improvement in provider-based clinical documentation accuracy to reflect patient acuity and severity.
Conduct concurrent record reviews and formulate compliant documentation queries to improve accuracy.
Educate clinicians and facility management on documentation opportunities and coding reimbursement issues.
Banner Health is a large nonprofit health care system with hospitals, clinics, and research centers across multiple states. They focus on skilled and compassionate care using advanced technology to improve patient outcomes.
Lead clinical performance and drive quality outcomes across assigned ACOs, aligning with national strategy on value-based care initiatives.
Serve as a national clinical champion, influencing best practices and workflows for hypertension and risk management among partner practices.
Act as a thought partner to market leadership, contributing to growth and policy initiatives while representing the clinical voice in strategic workgroups.
Aledade is a public benefit corporation that empowers independent primary care practices to thrive in value-based care. Founded in 2014, we are the largest network of independent primary care in the country, with a collaborative, inclusive, and remote-first culture.
Perform medical claims audit reviews with a focus on the Home Health sector, applying medical review guidelines and documenting findings.
Collaborate with the audit team to identify vulnerabilities, generate audit letters, and support findings during appeals.
Maintain knowledge of coding systems (ICD-10, CPT-4, HCPCS) and regulatory changes to ensure high-quality, deadline-driven work.
Machinify is a leading healthcare intelligence company that delivers value, transparency, and efficiency to health plan clients using an AI-powered platform. Deployed by over 85 health plans, including many of the top 20, and representing more than 270 million lives, the company fosters a collaborative, fast-paced remote culture.
Support quality assurance and audit planning for the WTC Health Program
Analyze claims data to identify trends and recommend improvements
Maintain health plan codebook and ensure accurate medical coding standards
Advanced Technologies & Laboratories International, Inc. (ATL) provides expertise in quality assurance, claims processing, medical coding, and audit activities for the WTC Health Program. The company offers a competitive total compensation package and invests in professional growth through tuition reimbursement and certification programs.
Review patient medical records to determine why claims are denied and prepare compelling appeal arguments using clinical evidence and regulatory guidelines.
Search for supporting evidence and analyze insurance denial trends to provide feedback to hospitals and executive leadership.
Ensure compliance with HIPAA regulations and demonstrate excellent written communication skills in crafting appeal letters and hearing testimony.
PAM Health provides specialty healthcare services through over 70 long-term acute care hospitals, rehabilitation hospitals, wound clinics, and outpatient physical therapy locations in 17 states. With a collaborative culture and a focus on compassionate care, the company employs a dedicated team committed to high-quality patient outcomes and professional growth.
Deliver exceptional longitudinal care through comprehensive virtual consultations and personalized treatment plans.
Translate complex medical concepts into actionable recommendations that empower patients to take control of their health.
Collaborate with clinical and operations teams to refine protocols and enhance the member experience.
Hone Health is a healthcare company focused on proactive longevity and preventive medicine, combining diagnostics, technology, and concierge service. They are a growing team committed to building a diverse and inclusive culture.