Responsible for application of appropriate medical necessity tools to maintain compliance and achieve cost effective and positive patient outcomes.
Acts as a resource to other team members including UR Tech and AA to support UR and revenue cycle process.
Utilizes Payer specific screening tools as a resource to assist in the determination process regarding level of service and medical necessity.
Virtua Health strives to connect individuals to the care they need, building a healthier community in South Jersey. They are a Magnet-recognized health system with over 14,000 colleagues, including over 2,850 doctors, physician assistants, and nurse practitioners.
Work primarily remotely with the patient’s medical practice staff and Guidehealth’s Case Management team to manage a targeted population of patients.
Assist patients in achieving better health outcomes by addressing their questions, connecting them with the medical practice, and implementing high-impact care plans.
Document patients’ medical history and medical issues accurately in the electronic health record (EHR).
Guidehealth is a data-powered, performance-driven healthcare company dedicated to operational excellence, making great healthcare affordable and improving patient health.
Develop trusting long-term patient relationships and empower you to do the best work of your career. Conduct holistic assessments to identify conditions, functional status and member values. Support chronic disease management, using motivational interviewing techniques.
Devoted Medical was founded on the belief that if we treat each member like we would our loved ones, we can meaningfully improve healthcare experiences.
Provide utilization management services, transition of care, and support to members and health care providers.
Utilize clinical knowledge to interpret medical policy and provide consultation on UM requests.
Proactively assess and assist members through the continuum of care by utilizing services and resources efficiently.
Wellmark is a mutual insurance company owned by its policy holders across Iowa and South Dakota, and it has built its reputation on over 80 years of trust.
Authorizes and reviews utilization of mental health and substance abuse services.
Collects and analyzes utilization data and assists with discharge planning and care coordination.
Provides member assistance with mental health and substance abuse issues, and participates in quality improvement projects.
Magellan Health, Inc. is committed to making a difference in the healthcare industry and communities. They value professional growth and development, total health and wellness, rewards and recognition, as well as employee unity, offering a place where you can thrive.
Provide health assessments and treatment solutions via telephone, video, or chat functions.
Track and monitor follow-up calls, escalate when appropriate.
Receive inbound phone calls from patients seeking answers to various medical conditions.
PWNHealth is a national clinician network working to improve early detection and prevention of disease using advanced diagnostics and telehealth. They are a mission-driven, positive culture made up of the best and brightest in the industry.
Provide online/video and phone remote clinical support to facility employees.
Provide timely, high quality clinical recommendations grounded in evidence based practice.
Provide input into resident care plans in collaboration with the in-centre team.
Summerset is the second largest retirement village operator in New Zealand, providing quality service to clients with 39+ villages from Whangarei down to Dunedin.
Manage a panel of seriously ill patients through telemedicine, ensuring visit frequencies align with patient acuity.
Communicate with patients via phone and video conferencing as outlined in the care plan, providing care within your scope of practice and per provider orders.
Develop and update care plans based on ongoing assessments, managing medications and coordinating with the Interdisciplinary team and external agencies.
Vynca's mission is to provide comprehensive care for more quality days at home.