Supports clinical safety, accuracy, and oversight of integrated AI tools by reviewing AI-assisted outputs and surfacing risks.
Applies nursing judgment to review charts, calls, messages, and other member interactions to assess quality, safety, and member experience.
Assists with data collection and basic analysis for quality and safety work, and participates in cross-functional improvement efforts.
Included Health is a healthcare company delivering integrated virtual care and navigation. They are on a mission to raise the standard of healthcare for everyone, and offer members care guidance, advocacy, and access to personalized virtual and in-person care.
Support payer audits and medical record reviews, ensuring timely submission of documentation.
Manage medical review requests and appeals associated with CMS contractors and regulatory agencies.
Review clinical documentation using audit checklists and partner with teams to gather required records.
VitalCaring is a provider of home health and hospice services founded in 2021. They are a growing company focused on quality and compliance, with a mission to deliver exceptional patient care.
Conduct telehealth assessments and support patients through their medical journey at Alternaleaf Clinic.
Manage complex patient interactions including clinical escalations, adverse event follow-up, and complaint resolution.
Build strong knowledge of the medicinal cannabis framework and patient journey systems.
Montu is Australia's largest healthtech business specializing in alternative healthcare, supporting patients, doctors, and pharmacies through its Alternaleaf clinic, SAGED platform, and Leafio dispensing solutions. Recognized as the fastest-growing tech company in Australia by Deloitte TechFast 50 for two consecutive years and named #1 on LinkedIn's Top Startups Australia 2024, Montu has a team that values innovation and impact.
Manage the member's clinical experience from request through desired outcome, including account activation and medical history drafting.
Coordinate video or phone consults with specialists and schedule monitors in advance, troubleshooting issues as needed.
Conduct ongoing follow-up post-consult and facilitate local recommendations, communicating with primary care physicians or specialists.
Transcarent is a health and care platform that combines medical, pharmacy, and point solutions with a generative AI-powered experience for health consumers. With over 1,700 employer and health plan clients serving 21 million Members, they foster a culture of People First, Care, Resilience, Results, and Humble and Human.
Perform concurrent and retrospective reviews on all facility and appropriate home health services.
Monitor level and quality of care and proactively manage acutely and chronically ill patients.
Act as liaison to Plan Medical Director and coordinate interdisciplinary approach.
Curana Health is a national leader in value-based care for senior living communities and skilled nursing facilities. Founded in 2021, they serve 200,000+ seniors in 1,500+ communities across 32 states with a team of over 1,000 clinicians.
Deliver virtual, patient-centered care with empathy and clinical excellence.
Triage patient concerns using evidence-based protocols and sound clinical judgment.
Coordinate laboratory follow-ups, referrals, and diagnostic services across the care team.
MyLaurel is a healthcare organization delivering virtual acute care support to vulnerable patients. They are a collaborative, high-performing team focused on transforming healthcare delivery.
Perform clinical reviews for medical necessity, level of care, and authorization-related denials.
Apply payer-specific guidelines and internal policies to support clear, defensible clinical narratives.
Meet assigned turnaround times and document findings accurately in designated systems.
CorroHealth helps clients exceed their financial health goals through scalable reimbursement solutions and clinical expertise, leveraging technology and analytics. The company builds long-term careers by investing in professional development and personal growth, fostering a culture of accountability and success.
Pulling, sorting, and analyzing data to determine member eligibility for the Population Health management Program.
Coordinating and providing care that is timely, effective, equitable, safe, and member-centric while following HMO processes.
Managing case assignments which includes outreach, documentation, monitoring for case progression, and case closure.
Guidehealth is a data-powered healthcare company dedicated to operational excellence. They aim to make healthcare affordable, improve patient health, and restore fulfillment in practicing medicine. Guidehealth is a growing and innovative organization and employees are expected to adapt to evolving business needs.
Provide clinical review and correspondence for utilization management, including medical necessity reviews and member communications.
Collaborate with Medical Directors to ensure evidence-based decisions that meet NCQA and CMS standards.
Maintain productivity and quality while working 100% remotely in a fast-paced environment.
Cohere Health’s clinical intelligence platform and agentic AI-powered solutions connect health plans’ strategic goals and providers’ needs, optimizing the speed, cost, and quality of care. With over 250 employees, the company fosters a supportive, growth-oriented environment and has been named to the Inc. 5000 list and a Top 5 LinkedIn Startup.
Provide clinical support and handle medical inquiries via a ticketing system with empathetic written communication.
Manage inbound and outbound calls to address patient queries and offer support.
Maintain accurate documentation and collaborate with internal teams across time zones.
Eucalyptus is a digital healthcare company on a mission to make good health last a lifetime, building clinics like Juniper for weight management and other personalized care programs. The company, now part of Hims & Hers, has supported over 350k patients, achieved 130% YoY revenue growth, and operates across multiple countries.
Perform case reviews and process requests for elective services and durable medical equipment.
Collaborate with physicians, vendors, and providers to ensure regulatory compliance and timely service.
Provide high-quality customer service to members and healthcare professionals.
Elderplan provides Medicare and Medicaid managed care health plans designed to help people stay independent. They are part of MJHS, a supportive community committed to excellence, respect, and collaboration.
Perform concurrent inpatient utilization review using InterQual criteria to determine medical necessity.
Engage in clinical collaboration with physicians and care teams to support appropriate level-of-care decisions.
Maintain documentation, comply with regulations, and ensure quality customer service.
WNS, part of Capgemini, is an Agentic AI-powered leader in intelligent operations serving over 700 clients across 10 industries. With over 66,000 employees across 13 countries and 65 delivery centers, the company combines scale and expertise to create meaningful impact.
Provide patient-focused telehealth clinical triage assessments and health education via phone, video, and chat.
Work independently to make clinical decisions, assess needs, and direct patients to appropriate care levels while documenting interactions.
Monitor performance metrics, participate in coaching sessions, and communicate with clients and team members.
Carenet Health is a behind-the-scenes partner for over 250 of the nation's premier health plans and health systems, providing telehealth and virtual care clinical triage assessments and health education. Named one of America's fastest-growing private companies by Inc. Magazine for eight consecutive years, the company is integrity-driven and focused on compassionate, evidence-based care.
Analyze denied insurance claims and apply clinical reasoning to determine appeal merit.
Draft persuasive, medically sound appeal letters to recover denied revenue.
Collaborate with legal team to ensure appeals are compelling and complete.
Ternium specializes in resolving complex healthcare insurance claim denials and delays for hospitals. They have a dedicated, mission-driven team and value diversity and inclusion.
Conduct clinical reviews of medical records to determine medical necessity and payer compliance.
Evaluate denial cases including appeals, audits, and no-authorization determinations.
Develop evidence-based clinical rationales aligned with payer and regulatory guidelines.
This partner company provides clinical review and healthcare reimbursement support services. The team is remote and operates in a fast-paced, performance-driven environment.
Provide clinical expertise, investigation, and problem-solving for complex, high-risk psychiatric cases.
Respond to safety concerns, resolve grievances, and identify areas for improvement across teams and providers.
Advocate for safe, high-quality care while shaping tools and workflows to scale impact across the network.
Rula is reimagining behavioral health care delivery, focusing on access, quality, and patient safety. They are a remote-first company currently hiring in most U.S. states, fostering a culture of inclusion where employees feel safe, seen, heard, and valued.
Provide executive oversight of all clinical programs, including Behavioral Health and EAP services, establishing strategic direction and quality frameworks.
Lead and supervise AVP-level clinical leaders, ensuring accountability and cross-functional alignment across clinical operations.
Develop clinical strategies, policies, and procedures, oversee utilization management, and drive quality improvement initiatives.
Uprise Health transforms the delivery and accessibility of mental and behavioral healthcare, bringing whole person care to individuals worldwide. The company values compassion, integrity, collaboration, velocity, and advocacy, and seeks to foster a culture of care and support.
Conduct initial and follow-up telehealth assessments, initiating/adjusting plans of care, and coordinating with providers via a secure platform.
Interpret insights from the Circadia platform to prioritize high-risk patients, driving timely interventions to prevent decline and unnecessary ED visits.
Complete documentation/charts within the same day, efficiently completing 25+ tele visits per day for home health patients in the SoCal/OC area.
Circadia Health is a healthcare AI company focused on preventing avoidable hospitalizations and transforming senior-care operations. They have a platform that combines contactless sensing with predictive models and enterprise integrations, touching 40,000+ post-acute patients daily.
Serve as primary clinician support contact for Ambience's AI documentation tools, resolving technical issues via Intercom and email with empathy.
Diagnose and fix complex platform, EHR integration, and user configuration issues, escalating as needed to Engineering and Product teams.
Build and maintain support resources, respond to on-call alerts, and contribute to reporting on CSAT, FCR, and handling times.
Ambience Healthcare builds an AI intelligence platform that restores humanity to healthcare by removing administrative burdens for providers. It is a fast-growing startup backed by top venture firms, ranked #1 in KLAS Research, and recognized by Fast Company and LinkedIn as a top startup in 2024 and 2025, with a high-ownership culture.
Provide direct clinical support to patients undergoing medication abortion through telemedicine, including triage, assessment, and nursing guidance.
Deliver culturally responsive, evidence-based care ensuring every patient feels heard and supported during critical moments.
Maintain active RN licensure in CA and at least one other state, with bilingual Spanish fluency and 2+ years clinical experience.
Hey Jane provides safe, discreet medication abortion and reproductive health care via telemedicine, having helped over 100,000 patients. The in-house clinical care team includes board-certified doctors, advanced practice clinicians, nurses, and patient care advocates, fostering a mission-driven culture focused on equitable healthcare.