Lead an assigned therapy team while providing direct patient care and serving as first contact for clinical and operational issues.
Monitor productivity, documentation, and scheduling; support onboarding, coaching, and evaluations.
Collaborate with leadership to optimize workflows, quality assurance, and regulatory compliance.
Ascend Healthcare provides integrated psychiatric and behavioral health services, including medication management, counseling, and care coordination. The culture emphasizes collaboration, patient-first care, and remote work.
Lead, coach, and onboard Utilization Management nurses while managing daily workloads and escalations.
Ensure reviews and determinations are timely, accurate, and compliant with CMS and Clover policies.
Collaborate with Medical Directors and cross-functional teams to improve workflows and member outcomes.
Clover Health provides data-driven healthcare plans for seniors, using the Clover Assistant to support physician decisions. The company is a mission-driven team of diverse experts focused on improving members' quality of life.
Conduct quality audits and validate provider data to ensure accuracy, integrity, and compliance with regulatory standards.
Analyze trends, investigate discrepancies, and recommend corrective actions to strengthen provider network operations.
Collaborate with cross-functional teams to document evidence, support accreditation reviews, and drive continuous improvement.
Alliance Health is a managed care organization that coordinates services for individuals with complex needs in North Carolina. They foster a collaborative, mission-driven culture focused on quality, compliance, and remote work flexibility.
Analyze and summarize medical records, highlighting relevant clinical findings for attorneys.
Prepare medical chronologies and long-term care assessments to support case evaluations.
Provide objective, evidence-based medical insights and coordinate with expert witnesses.
The partner company provides specialized legal nurse consulting services to attorneys, analyzing medical records and supporting injury-related cases. This role offers flexible, part-time contract work in a fully remote environment.
Oversee delegated audits related to UM, Credentialing, Claims, Enrollment, and Appeals processes to ensure compliance with payer contracts.
Educate staff, update policies and workflows, and act as a liaison between payers and local market leadership during audits.
Operationalize regulatory communications from governing bodies and document process changes for upstream and downstream teams.
Dignity Health Management Services offers integrated management and business services to healthcare providers, focusing on managed care administrative and clinical services to contain costs and improve quality. It is part of CommonSpirit Health, a large health system with a mission-driven culture centered on community and patient care.
Conduct clinical and billing reviews of claims, itemized bills, and UB-04 forms to ensure accuracy.
Perform utilization reviews to assess medical necessity and validate charges against policies.
Mentor reviewers, meet productivity targets, and maintain active RN licensure with CEUs.
Our partner is a healthcare services company that conducts medical claims and utilization reviews to ensure accurate billing and appropriate care. They offer a collaborative, quality-focused remote environment with opportunities for professional development.
Provide timely, high quality clinical recommendations grounded in evidence-based practice.
Communicate assessment findings and provide advice to the in-centre team.
Coach targeted care team members and use technology including Microsoft Teams and electronic resident management systems.
Summerset develops and operates retirement villages across New Zealand, providing care and services that bring the best of life to residents. Their culture is built on teamwork, care, and a drive for excellence, with a strong sense of values.
Lead premium audit strategy and operations to ensure regulatory compliance and financial integrity.
Oversee audit quality, data integrity, and implementation of business-wide improvements.
Manage budgets, workforce planning, vendor relationships, and team development.
The company is an insurance organization specializing in workers' compensation premium audit operations. It fosters a collaborative work environment with a focus on integrity, customer service, accountability, innovation, and employee fulfillment.
Conduct clinical reviews of inpatient admissions and continued stays using approved medical necessity criteria.
Collaborate with physicians, care managers, and payer teams to resolve utilization concerns and prevent denials.
Support quality improvement initiatives, maintain accurate documentation, and communicate review outcomes effectively.
This role is with a partner company focused on healthcare utilization management, helping hospitals improve patient outcomes and ensure appropriate resource use. The team operates as a distributed remote group supporting care coordination, revenue integrity, and clinical compliance.
Evaluate AI-generated clinical interactions for accuracy, safety, and appropriateness.
Annotate and score AI responses against evidence-based protocols and structured rubrics.
Provide detailed written feedback and participate in calibration sessions to enhance AI reliability.
The company focuses on improving AI-powered clinical solutions by leveraging clinical expertise. It is an early-stage partner organization offering flexible, remote contract opportunities for healthcare professionals.
Lead and supervise a team of regulatory specialists managing labeling approvals, drug listings, and medical device submissions.
Oversee FDA compliance, quality investigations, and health hazard evaluations to ensure product integrity.
Collaborate cross-functionally with Quality Assurance, Legal, and external partners to resolve complex regulatory challenges.
The partner company is a pharmaceutical and medical device organization focused on ensuring regulatory compliance and product quality. The company fosters a collaborative and inclusive work environment, emphasizing continuous improvement and professional development.
Review inpatient medical records to validate DRG coding accuracy.
Apply clinical judgment to identify discrepancies, coding errors, and overpayments.
Document evidence-based audit findings and meet quality standards.
The company specializes in healthcare claims auditing and analytics, improving accuracy and consistency in payments. It is a collaborative, fully remote environment that values precision, teamwork, and continuous improvement.
Manage and triage patient vital signs remotely, using motivational interviewing to drive positive health behavior changes.
Perform monthly wellness calls with patients, collaborating with care teams to set patient-centric goals.
Escalate urgent care needs appropriately and meet program engagement metrics in a remote MST-based role.
Vivo Care is building a future where care is continuous, personal, and connected, challenging the status quo in healthcare. We are a fast-growing startup where everyone has a voice, fostering a culture of inclusion, collaboration, and innovation.
Serve as lead clinician and engagement manager, guiding clients through complex medical care and advocating for the best possible health outcomes.
Collaborate with clinical and research teams to identify data-supported care options and coordinate with top experts worldwide.
Build strong client relationships, provide high-level clinical education, and manage other clinical staff on specific cases.
Private Health Management guides patients and families through the chaos and complexity of serious medical care, providing independent advocacy and support to achieve better outcomes. It is a fully remote company with employees across the United States, focused on delivering personalized care.
Deliver comprehensive, coordinated health services remotely using telehealth and digital tools.
Assess patients' medical, physical, and psychological status and develop interdisciplinary care plans.
Support enterprise-wide Virtual Health Services implementation, including travel to hospitals for expansions.
CommonSpirit Health is a nonprofit Catholic healthcare organization providing integrated health services and virtual care across 24 states. With over 157,000 employees and 45,000 nurses, it fosters a culture of humankindness and delivers more than 20 million patient encounters annually.
Supports the review of pharmacies, dispensers, and manufacturers to ensure adherence to Medicare Part D requirements.
Develops investigative strategies, compliance processes, and risk assessments with clear, actionable findings.
Collaborates with CMS, OIG, legal, audit, and other stakeholders while mentoring junior staff.
Attain Talent is a recruitment and staffing firm that connects professionals with organizations across various industries. They are committed to fair and equitable compensation practices and fostering an inclusive workplace.
Coordinate interdisciplinary care plans and serve as a liaison between patients, providers, and insurance partners.
Provide telephonic nursing triage, health guidance, and on-call support according to agency protocols.
Manage lab results, referrals, prescription refills, and patient follow-up to ensure continuity of care.
Planned Parenthood of the Pacific Southwest provides sexual and reproductive healthcare across 20 health centers in Southern California. The organization fosters a collaborative, mission-driven culture with over 100 years of advocacy.
Perform prospective, concurrent, and retrospective utilization review to ensure medical necessity and appropriate level of care.
Research and respond to appeals, coordinate discharge planning, and analyze care patterns.
Collaborate with providers and internal teams to resolve benefit and eligibility issues.
HealthEdge provides AI-powered operational infrastructure for health insurance companies, helping them modernize operations and compete effectively. The company is expanding and investing in its people, offering opportunities to shape the future of healthcare technology.
Lead complex client implementations, from customer use cases to success metrics and clinical workflows.
Train and educate customers on BioIntelliSense product offerings and value proposition.
Provide ongoing clinical support and post-implementation optimization while coordinating across teams.
BioIntelliSense is a healthcare technology company providing FDA-cleared wearable monitors, like the BioButton, and AI-driven analytics for early detection of patient decline. The company has a remote-first culture with a global team and offices in Colorado and California.
Shape enterprise strategy for provider data quality, governance, and directory accuracy across a nationwide healthcare network.
Lead governance frameworks, auditing programs, and compliance with CMS requirements.
Drive innovation through automation, analytics, and executive stakeholder collaboration.
This role is with a partner company in the healthcare sector, operating a nationwide provider network focused on data quality and governance. The company emphasizes innovation, enterprise-wide transformation, and data-driven decision-making.