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.
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.
Review and evaluate electronic medical records of emergency department admissions to screen for medical necessity using InterQual or MCG criteria.
Apply evidence-based clinical guidelines to assess and ensure proper utilization of healthcare resources.
Enter clinical review information into the system for transmission to insurance companies for authorization.
Netsmart provides advanced healthcare technology solutions for post-acute and human services clients, enabling better care through a comprehensive platform. We are a vision-driven team passionate about innovation, and we have been recognized as one of the best companies to work for.
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.
Supervise daily operations of clinical compliance auditors and specialists.
Assist in developing coordinated team processes and managing UM and PHM plan adherence.
Serve as clinical services liaison to senior management and ensure timely documentation.
Guidehealth is a data-powered healthcare company focused on operational excellence and value-based care. They emphasize empathy, AI, and collaboration, with a remote-first culture.
Provide telehealth clinical triage assessments and health education to diverse populations via phone, video, and chat.
Utilize critical thinking and clinical skills to assess patient needs, direct to appropriate care, and influence health decisions.
Document interactions and monitor performance metrics while participating in coaching sessions to improve quality.
Carenet Health provides telehealth and virtual care clinical triage assessments, health education, and services to patients and health plan members. The company has been named one of America's fastest-growing private companies by Inc. Magazine for eight consecutive years and fosters a culture of compassion, innovation, and work-life balance.
Manage UM nurse team performance, SLAs, and quality improvement.
Handle escalated UM cases and provider disputes 25% of time.
Partner with clients, medical directors, and IDTs to ensure consistent decision-making.
IntusCare builds an end-to-end ecosystem for Programs of All-Inclusive Care for the Elderly (PACE) to improve care, financial performance, and compliance. As a healthcare technology company, we empower teams to improve outcomes for dual-eligible seniors.
Conduct medical necessity reviews for inpatient admissions and post-acute services using evidence-based guidelines.
Lead peer-to-peer discussions with attending physicians to clarify clinical documentation and support appropriate care decisions.
Collaborate with utilization management and care management teams to ensure consistent, cost-effective care.
Our partner company provides utilization management services for Medicare Advantage members, focusing on evidence-based clinical decision-making. It operates with a collaborative, matrixed team and emphasizes regulatory compliance and patient-centered care.
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.
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.
Review Home Health prior authorization requests using CMS guidelines and clinical judgment.
Lead and mentor the Home Health UM nursing team, ensuring quality and compliance.
Collaborate with cross-functional partners to optimize care and improve utilization.
Clover Health provides high-quality, affordable healthcare for America's seniors by combining data, technology, and preventive care. They are a mission-driven team with diverse expertise, focused on improving members' lives through innovation and empathy.
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.
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.
Conduct telehealth visits for patients in the House Calls program, managing chronic conditions and geriatric syndromes.
Perform care management assessments, coordinate care with providers, and document accurately in the EMR.
Ensure compliance with clinical protocols and participate in interdisciplinary case reviews.
Essen Health Care is the largest privately held, multispecialty medical group in New York, providing high-quality, compassionate care to underserved residents. Founded in 1999, the network has grown to 50+ locations with 500+ providers, fostering a team-oriented culture focused on population health.
You are responsible for supporting care delivery by partnering with Advanced Practice Providers to execute individualized care plans for patients with chronic kidney disease, hypertension, diabetes, and congestive heart failure.
This role focuses on enhancing clinical outcomes, patient engagement, and care coordination through education, remote monitoring, medication management, and longitudinal patient support.
Key responsibilities include visit preparation, care plan execution, disease management education, medication management, quality measure support, and cross-functional collaboration.
Evergreen Nephrology partners with nephrologists to transform kidney care through a value-based, person-centered approach. They are a growing company building a healthcare delivery model focused on improving patient outcomes and quality of life, with a robust team and culture that emphasizes innovation and support.
Provide after-hours triage, clinical assessment, and interventions via phone to support patients and families.
Coordinate care with physicians, facilities, and internal teams while dispatching visits and managing vendor services.
Document all interactions accurately in the EMR and review team documentation for compliance.
Moments Hospice is a hospice care provider dedicated to delivering compassionate, patient-centered end-of-life support. The organization fosters a structured, supportive culture with experienced leadership and opportunities for internal growth.
Provides disease-specific management and oncology care coordination for patients and families throughout treatment.
Documents assessments and interventions in real time, collaborates with oncologists, and proactively manages symptoms.
Requires two years of oncology experience, an active RN license, and strong computer skills for a remote work environment.
AON is an alliance of physicians and veteran healthcare leaders dedicated to ensuring the long-term success and viability of oncology diagnosis and treatment in community-based settings. It is the fastest growing national network of community oncology practices, employing staff across the country to empower physicians and deliver exceptional cancer care.
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.
Provide exceptional care, disease management and health education to patients.
Support goal setting for individual patients to help them better manage chronic conditions.
Coordinate with other clinical team members to provide an exceptional patient experience.
Salvo Health is a tech-enabled healthcare company focused on chronic gut and metabolic conditions. Backed by leading health investors, it offers a multidisciplinary care team approach with board-certified specialists and digital tools.
Provide on-demand telephone-based care management services through a 24/7 Nurse Advice Line.
Assess symptoms and concerns of callers to determine urgency and type of care needed.
Coordinate care across the healthcare delivery system and record patient data in medical record systems.
Privia Health is a technology-driven, national physician enablement company that collaborates with medical groups, health plans, and health systems to optimize physician practices and improve patient experiences. The company is led by top industry talent and physician leadership, and focuses on reducing healthcare costs and improving outcomes.