Play an active role in member registration and enrollment, including organizing community engagement and outbound outreach calls/texts.
Engage with a panel of assigned members to provide care navigation, appointment logistics, prescription drug support, lab support, referral coordination, care plan adherence support, and resource sharing.
Serve as the primary relationship holder for members with behavioral health needs; provide consistent outreach, follow-up, and re-engagement support, including after ED/inpatient discharge when applicable.
Zócalo Health is a tech-enabled, community-oriented primary care organization serving people who have historically been underserved by the one-size-fits-all healthcare system. They combine local, community-based teams with virtual care and modern technology to deliver coordinated, whole-person care where members live and receive support.
Help families get admitted to mental health treatment programs over the phone.
Conduct initial assessments of needs and coordinate the admission process.
Enter notes into Salesforce and provide follow-up to web inquiries.
Embark Behavioral Health provides mental health treatment programs. They are committed to enriching the therapeutic and healing experience through the diversity of its employees and community.
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, 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 provide high-technology health plans that expand benefits, increase access and transparency, and feature a personalized, human approach. Evry Health is the major medical division of Globe Life (NYSE:GL), which has 16.8 million policies in force, and more than 3,000 corporate employees and 15,000 agents.
Provides non-clinical administrative support to Case Managers and Care Coordinators.
Obtains and manages medical documents, ensuring accurate record retrieval.
Prioritizes tasks based on expedited requests with attention to detail.
Spectrum Healthcare Resources (SHR) delivers systems and processes designed to meet the unique needs of Military and VA Health Systems. They provide physician and clinical staffing and management services to United States Military Treatment Facilities, VA clinics and other Federal Agencies.
Reaches out to members telephonically to assist with referrals, authorizations, HHC, DME needs, medication refills, make provider appointments and follow ups, etc.
Creates cases, tasks, and completes assessments in Case Management module for all Hospital and SNF discharges
Works as a team with the Case Manager to engage and manage a panel of SNP members
Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve.
Build trusting relationships with patients, families, and providers, addressing health questions and care needs.
Identify medical, behavioral, social, emotional, and financial needs to support whole‑person care.
Strengthen the connection between patients and healthcare providers by addressing barriers and facilitating communication.
Guidehealth is a data-powered, performance-driven healthcare company dedicated to operational excellence, with the goal to make great healthcare affordable, improve patient health, and restore fulfillment for providers. They leverage remotely-embedded Healthguides™ and a centralized Managed Service Organization to build stronger connections with patients and providers.
Assist in monitoring compliance of medication prescribed by the physician or psychiatric provider.
Facilitate partnerships between patients, personal providers, and family when appropriate.
Provide psychoeducation, coping skills, and therapeutic worksheets through a structured care plan.
Optima Medical is an Arizona-based medical group with over 130 medical providers, caring for more than 200,000 patients statewide. They focus on personalized healthcare, aiming to help communities "Live Better, Live Longer" by preventing leading causes of death.
Assess member needs in physical health, mental health, and social supports.
Oversee the development of client care plans and goal settings.
Connect clients to social services, advocate for their needs, and ensure documentation.
Vynca is dedicated to transforming care for individuals with complex needs, fostering a close-knit community committed to caring for each other and the people they serve. Guided by core values like excellence and compassion, Vynca empowers employees to make a profound difference in providing comprehensive care for more quality days at home.
Guides clients and families in recognizing the value of continuing care within Embark programs.
Builds trusted relationships with clients, families, and referral sources.
Collaborates with Embark programs nationwide to develop and execute individualized continuing care plans.
Embark Behavioral Health guides individuals and families through a full continuum of care. They support clients as they transition between levels of treatment.
Responsible for coordination of services for members, emphasizing education/self-management and quality care. \n- Assesses member needs, reviews service options, develops and implements care plans, and coordinates resources. \n- Manages a caseload of moderate-high risk members with complex medical/behavioral/psychosocial needs.
Capital Blue Cross is committed to improving the health and well-being of our members and the communities in which they live. They offer flexibility, prioritize health and well-being, and encourage employees to volunteer in their community.
Provides after hours support to members and leaders seeking services.
Problem-solves and assists with high touch and escalated/sensitive calls.
Spring Health is on a mission to revolutionize mental healthcare by removing every barrier that prevents people from getting the help they need, when they need it. They partner with over 450 companies, from startups to multinational Fortune 500 corporations, providing care for 10 million people.
Provide case management to members including medical, social, psychological, physical, and spiritual needs.
Develop, implement, and monitor the care plan in conjunction with the PCP, caregivers, and other team members.
Help meet the member's needs.
Elderplan and HomeFirst are Medicare and Medicaid managed care health plans that are expanding services in response to patients' needs. At MJHS, they are a supportive community committed to excellence, respect, and providing high-quality, personalized health care services.
Coordinate and support the hospital’s Utilization Review and Case Management program.
Review patient charts and clinical documentation to verify medical necessity.
Monitor patient progress and coordinate care management strategies.
NeuroPsychiatric Hospitals is a national leader in behavioral healthcare, specializing in patients with acute psychiatric and complex medical needs. With hospitals in Indiana, Michigan, Texas, and Arizona, they’re expanding access to their unique model of care across the United States.
Complete all documentation associated with client calls.
Complete all required reports associated with Needs Assessment/Referral Development.
Pyramid Healthcare is dedicated to offering high-quality care in addiction treatment, mental health recovery, and eating disorder treatment. They focus on client-centered care and comprehensive behavioral healthcare, supporting clients at every recovery stage.
Maintain full ownership and accountability for initiating phone contact to potential study participants.
Conduct phone-based pre-screening interviews for potential study participants to determine pre-qualification status.
Consistently provide outstanding customer service with every patient interaction.
M3 Wake Research is an integrated network of premier investigational sites meeting clinical research needs. They have close to 30 owned and managed research sites across the country and continue to grow through acquisitions.
Processes acute and post-acute inpatient medical and select intensive outpatient higher level of care requests through clinical review.
Interprets and applies InterQual criteria, CMS-issued guidelines, Capital Blue Cross Medical Policies to requests.
Collaborates with UM department staff and Medical Directors to make a final determination, and with Care Management staff on discharge planning.
Capital Blue Cross is an independent licensee of the Blue Cross Blue Shield Association. At Capital, employees work alongside a caring team of supportive colleagues and are encouraged to volunteer in their community.
Review medically complex claims, pre-authorization requests, appeals, and fraud/abuse referrals.
Assess payment determinations using clinical information and established guidelines.
Evaluate medical necessity, appropriateness, and reasonableness for coverage and reimbursement.
Broadway Ventures transforms challenges into opportunities with expert program management, cutting-edge technology, and innovative consulting solutions. As an 8(a), HUBZone, and Service-Disabled Veteran-Owned Small Business (SDVOSB), they empower government and private sector clients by delivering tailored solutions that drive operational success, sustainability, and growth.
Provides patient care modalities of evidence-based practices to best meet the clinical needs of the patients.
Review and signature of patient clinical Psychosocial assessment, diagnosis, treatment plan, and consents as needed for the patient in a timely manner.
Maintenance of the clinic record, including documentation of activities performed as part of the service delivery process.
Ascend Healthcare provides fully integrated, quality psychiatric and behavioral health services in a compassionate, convenient, and affordable manner. Ascend Telehealth brings a professional, collaborative, and rewarding workplace culture towards our goal to create a profound impact on the mental health of diverse communities.
Complete timely review of healthcare services using appropriate medical criteria to support determinations.
Document clinical findings and rationale clearly and accurately in accordance with federal/state regulations, URAC standards, and Guidehealth policies.
Communicate precertification and concurrent review decisions—verbally and in writing—to required parties within defined timeframes.
Guidehealth is a data-powered, performance-driven healthcare company dedicated to operational excellence. They aim to make great healthcare affordable, improve patient health, and restore fulfillment in practicing medicine for providers. Driven by empathy and powered by AI and predictive analytics, Guidehealth leverages Healthguides™ and a Managed Service Organization to build stronger connections with patients and providers.