Conducts medical necessity reviews to determine appropriate patient class designation.
Performs timely reviews using InterQual Criteria and clinical nursing judgement.
Communicates with the provider team regarding patient class designation and medical necessity.
Emory Healthcare fuels professional journeys with benefits, resources, mentorship, and leadership programs. They offer a supportive environment for career growth.
Assess referred concurrent denials and determine next steps for resolution.
Review medical record documentation to support denial management strategies.
Advocate for patients to ensure coverage and reimbursement.
They are currently looking for a Utilization Management Coordinator. By enhancing operational efficiencies and implementing educational initiatives, this role significantly impacts the financial and quality outcomes of healthcare delivery.
Assess, plan, coordinate, and monitor patient care.
Develop, implement, and monitor individualized care plans.
Coordinate care across providers, facilities, and community resources.
Limitlessli specializes in recruiting, hiring, and managing high-caliber remote staff for dynamic and growing healthcare facilities. They connect clients with highly qualified professionals, offering tailored services to meet unique business needs, leveraging an extensive global network.
Provide first level review for all outpatient and ancillary pre-certification requests.
Work with hospital staff to prepare patients for discharge and ensure a smooth transition to the next level of care.
Complete documentation for all reviews in Eldorado/Episodes and maintain confidentiality.
Personify Health created a personalized health platform bringing health plan administration, holistic wellbeing solutions, and comprehensive care navigation together. Their team is on a mission to empower people to lead healthier lives.
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.
Reviewing cases, educating patients on appropriate care.
Managing health care costs for the dependents of our Nation’s Active Duty and eligible retirees.
Working remotely Monday through Friday, 8 hours per day.
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 and VA clinics.
Perform comprehensive medical record and claims review to make payment determinations for Medicare PART A.
Conduct in-depth claims analysis utilizing ICD-10-CM, CPT-4, and HCPCS Level II coding principles.
Make clinical judgment decisions based on clinical experience when applicable.
Empower AI provides federal agency leaders with tools to elevate their workforce's potential through meaningful transformation. Headquartered in Reston, Va., Empower AI leverages three decades of experience solving complex challenges in Health, Defense, and Civilian missions.
Contact patient and complete a thorough assessment, including physical, psychosocial, emotional, spiritual, environmental, and financial needs.
Develop treatment plan for standard and catastrophic cases in collaboration with the patient, caregivers or family, community resources and multi-disciplinary healthcare providers that include obtainable short- and long-term goals.
Advocate for the patient by facilitating the delivery of quality patient care, and by assisting in reducing overall costs; provide patient/family with emotional support and guidance.
Personify Health created the first and only personalized health platform—bringing health plan administration, holistic wellbeing solutions, and comprehensive care navigation together in one place. They serve employers, health plans, and health systems with data-driven solutions that reduce costs while actually improving health outcomes and have a mission to empower people to lead healthier lives.
Perform comprehensive medical record and claims review to make payment determinations for Medicare Durable Medical Equipment.
Conduct in-depth claims analysis utilizing ICD-10-CM, AMA-CPT, and HCPCS Level II coding principles.
Make clinical judgment decisions based on clinical experience when applicable.
Empower AI provides AI tools for government to elevate workforce potential. They have three decades of experience solving complex challenges in Health, Defense, and Civilian missions and are headquartered in Reston, VA.