Source Job

• 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.

• Provide timely medical reviews based on evidence-based criteria and clinical acumen.
• Clearly document all decisions and communicate with members and providers.
• Conduct peer-to-peer discussions with treating providers to explain review outcomes and alternatives.

Cohere Health uses a clinical intelligence platform and agentic AI to connect health plans and providers, optimizing care speed, cost, and quality. They are a growing company recognized as a top startup and backed by leading investors, fostering a supportive and diverse environment.

• Provide medical management and utilization management decisions within scope of authority, ensuring compliance with regulations and client expectations.
• Conduct medical necessity reviews for rehabilitation services including physical therapy, occupational therapy, speech therapy, chiropractic, and acupuncture.
• Support delegated appeals processes, quality assurance, and telehealth consultation while collaborating with senior medical directors and clinical teams.

Our partner is a healthcare organization that provides physician-led clinical oversight across utilization management, medical necessity review, quality management, and virtual healthcare support. The company operates with a collaborative team of senior medical leadership and clinical staff, offering a remote work environment and part-time opportunities.

• Perform patient assessments, develop differential diagnoses, and create individualized care plans via telemedicine.
• Order and interpret diagnostic tests, prescribe medications, and provide patient education and counseling.
• Collaborate with physicians and health care professionals to manage acute and chronic illnesses and promote disease prevention.

Cooper University Health Care is an academic health system in South Jersey committed to extraordinary patient care and clinical innovation. They offer a comprehensive benefits program, competitive compensation, and professional development opportunities.

• Complete assigned medication utilization reviews and medical necessity appeals for commercial and governmental clients.
• Provide peer-to-peer support to physicians and prescribers regarding clinical programs and utilization review decisions.
• Actively participate in developing utilization management criteria and clinical policy revisions.

Judi Health is an enterprise health technology company providing a comprehensive suite of solutions for employers and health plans, including pharmacy benefit management and health benefit management. They are rebuilding trust in healthcare in the U.S. and deploying infrastructure for better care, but no specific employee size or culture details are provided.

• Conduct approximately 20 telehealth visits per day with homebound Medicare patients.
• Serve as the supervising and collaborating physician for a pod of nurse practitioners and physician assistants.
• Review and sign care plans, conduct chart audits, and train care coordinators.

Ennoble Care provides mobile primary care, palliative care, and hospice services in multiple states, offering a continuum of care for patients with chronic conditions. They are a healthcare organization focused on home-based care, with a team that values their motto 'To Care is an Honor.'

• Provide telemedicine primary care with a focus on provider empanelment and continuity.
• Enjoy flexible scheduling in a 7-day-a-week operation with evenings and weekends.
• Utilize Circle Medical's proprietary EHR for seamless two-way video appointments.

Circle Medical is an adult-only primary care practice committed to high-quality, continuous care through a telemedicine-first approach. It uses a proprietary HIPAA-compliant EHR and supports providers with a strong care team.

• Collaborate with experienced PMHNPs treating low- and medium-acuity patients using evidence-based approaches.
• Conduct chart reviews, provide guidance on diagnoses and treatment plans, and authorize prescriptions when permitted.
• Mentor clinicians and reinforce clinical standards, documentation expectations, and responsible-prescribing protocols.

Legion is a pioneering, tech-enabled psychiatry network delivering world-class outpatient care. The company prioritizes clinical quality and a collaborative culture focused on expanding access to mental health care.

• Lead care management programs with strategic and operational oversight.
• Drive clinical performance metrics and evidence-based care models.
• Collaborate with cross-functional teams to integrate AI and improve population health.

The partner company is a healthcare organization focused on care management and population health. It operates with a remote-first culture and offers opportunities to influence innovative healthcare models.

• Lead the care, case, and utilization management programs, setting clinical direction and owning performance targets.
• Evolve clinical operating models and partner with Product and Engineering to integrate AI tools into workflows.
• Manage, develop, and retain clinical leaders while collaborating cross-functionally to coordinate care for members.

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, with a remote-first culture and a focus on breaking down barriers to high-quality care.

• Deliver safe, high-quality, patient-centered primary care across asynchronous and synchronous modalities.
• Build strong, longitudinal patient relationships and manage a fast-paced caseload of at least 20 asynchronous cases per day.
• Collaborate across clinical, product, and operations teams to improve care delivery and leverage AI-assisted workflows.

Sana is a health plan solution built for small and midsize businesses, offering integrated primary care services. The company is remote-first with a fully distributed team across the U.S., valuing curiosity, ownership, and speed.

• You will provide medical record reviews for second opinions without practicing acute care or prescribing medications.
• You can work from home or anywhere with internet access on your own schedule.
• You will be covered by top-rated medical malpractice coverage at a discount.

We provide comprehensive second medical opinions via a web-based platform. Our company size is not disclosed, but we offer a flexible, independent contractor culture.

• Provide high-quality virtual urgent care, including history, exams, diagnosis, treatment plans, and documentation.
• Collaboratively manage patients of all ages with acute, chronic, and mental health conditions, ordering diagnostics as needed.
• Maintain active medical licenses, board certification, and adhere to scheduling expectations including weekends and evenings.

Included Health is a healthcare company delivering integrated virtual care and navigation. They aim to raise the standard of healthcare for everyone, offering care guidance, advocacy, and access to personalized virtual and in-person care across various specialties.

• Provide high-quality virtual care to diverse populations across the country.
• Collaborate with a mission-driven team to transform healthcare delivery.
• Must have family medicine or emergency medicine board certification and 3+ years post-residency experience.

Included Health is a new kind of healthcare company, delivering integrated virtual care and navigation. Their mission is to raise the standard of healthcare for everyone by providing personalized virtual and in-person care.

• Conduct comprehensive virtual assessments, diagnoses, and evidence-based treatment for patients across various ages through video and text-based visits.
• Manage chronic conditions, provide preventive care, and order diagnostic tests while prescribing medications in compliance with regulations.
• Maintain accurate documentation in the EMR and ensure compliance with HIPAA and confidentiality standards.

Curai is a healthcare company that harnesses artificial intelligence and clinical expertise to make care more affordable and accessible. The team is mission-driven, collaborative, and committed to building a diverse and inclusive workforce.

• Conduct coverage reviews and render determinations based on member benefits and medical policies.
• Document clinical findings and actions in accordance with regulatory and accreditation requirements.
• Engage in peer-to-peer discussions with providers and collaborate on benefit determinations.

Capital Blue Cross is a health insurance company that provides coverage and services. They are consistently voted as one of the Best Places to Work in Pennsylvania, reflecting a positive culture.

• Provides medical interpretation and clinical review for appropriateness of services, including Home Care Solutions, Skilled Nursing Facility, Durable Medical Equipment, rehabilitation, and discharge planning.
• Advises executives on functional strategies related to OneHome initiatives and clinical priorities, exercising independent judgment on complex issues.
• Ensures compliance with CMS guidelines, Medicare/Medicaid requirements, and Humana policies while supporting quality, utilization management, and care coordination.

Humana is a leading U.S. healthcare company providing insurance and healthcare services through its Humana insurance and CenterWell healthcare services. It is a large, publicly traded organization with a culture focused on the Humana Way, emphasizing collaboration, accountability, and improving member experiences.