Build meaningful relationships with patients and families, understanding their goals, barriers, and motivators.
Creating personalized care plans that go beyond diagnoses, addressing social determinants, emotional well-being, and behavioral health when applicable.
Coordinate care across providers and settings, ensuring safety, quality, and continuity.
Guidehealth is a data-powered, performance-driven healthcare company dedicated to operational excellence. Our goal is to make great healthcare affordable, improve the health of patients, and restore the fulfillment of practicing medicine for providers.
Conduct outbound telephone outreach to patients and engage patients in pharmacist-led consultations.
Serve as a liaison between patients and pharmacies to resolve medication barriers.
Collaborate closely with Care Management Pharmacists to support medication adherence initiatives.
Evergreen Nephrology partners with nephrologists to transform kidney care through a value-based, person-centered, holistic, and comprehensive approach. They are committed to improving patient outcomes and quality of life by delaying disease progression and shifting care to the home.
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.
Deliver coordinated, patient-centered virtual Care Management by telephone or video that improves members' health outcomes.
Help members navigate complex medical conditions, treatment pathways, benefits, and the healthcare system in general.
Assist throughout acute healthcare episodes, such as hospitalizations and rehabilitation stays, providing coordinated Case Management to support the member and their family.
Included Health is a healthcare company that delivers integrated virtual care and navigation, aiming to raise the standard of healthcare for everyone. They break down barriers to provide high-quality care for every person, offering care guidance, advocacy, and access to personalized virtual and in-person care.
You will be responsible for using your assessment and communication skills to engage with patients in need of clinical support to determine and prioritize their needs.
Conduct timely telephonic clinical outreach to identified patients.
Collaborate with PCPs, NPs, and other members of the healthcare team to coordinate care for patients and actively help keep them stable at home.
Vytalize Health is building a market leader in value-based healthcare. They are a rapidly growing organization that embraces the power of AI and encourages innovative, responsible use of emerging technologies in their work.
Conduct assessments, establish care goals, and deliver telephonic coaching and education to support clients in managing chronic conditions.
Perform first‑level Utilization Review for inpatient and outpatient services based on plan guidelines.
Document all condition management activities, track client progress, and report outcomes, savings, and quality improvements.
HealthCheck360 focuses on reducing medical costs while increasing employee engagement and productivity. They accomplish this by providing onsite biometric screenings, engaging participants through technology and programming, educating the participant with risk-specific targeted communications, and supporting positive behavior change through Health Coaching and Condition Management programs.
Oversee the RN Reviewer team including one RN Team Lead
Manage the daily timeliness report and ensure all cases meet expected turnaround times
Monitor the nurse productivity reports daily and provide feedback to the nurses, managing performance to ensure consistency
Cohere Health's clinical intelligence platform delivers AI-powered solutions that streamline access to quality care by improving payer-provider collaboration, cost containment, and healthcare economics. They work with over 660,000 providers and handle over 12 million prior authorization requests annually.
Lead CCP operations across multiple service provider groups.
Manage a clinical workforce of 25–35 Care Managers and LVNs/LPNs.
Serve as Evergreen’s operational point of ownership for practice partners.
Evergreen Nephrology partners with nephrologists to transform kidney care through a value-based, person-centered, holistic, and comprehensive approach. They believe patients living with kidney disease deserve the best care and are committed to improving patient outcomes.
Take inbound calls from patients, providers and members
Support members with their insurance needs, questions or concerns
Answer inquiries on benefit claims, appeals, and authorizations
Carenet Health pioneers advancements for an experience that touches all points across the healthcare consumer journey. They interact with 1 in 3 Americans every day, delivering positive healthcare experiences and improving outcomes.
Conduct virtual wellness visits to patients in their homes.
Perform health risk assessments and medication reviews.
Provide comprehensive care coordination and management.
Sprinter Health is an on-demand mobile health service that sends medical professionals to patients’ homes. They are building the clinical and technological infrastructure to realize a future of healthcare untethered with a rapidly growing team of visionary leaders.
Deliver patient centric health coaching that integrates medical needs with patient preferences.
Triage patient reported symptoms and side effects according to internal protocols, escalating to Providers when appropriate.
Provide comprehensive diabetes, hypertension, hyperlipidemia, and weight management care and education via chat, phone, and video.
9amHealth is a specialized cardiometabolic care provider, offering custom care plans, prescription medications, and expert guidance to help members live healthier. They are a San Diego, California-based company with a small, flexible team and are backed by 7Wire Ventures, Human Capital, Founders Fund, and Define Ventures.
Provides quality driven telephonic clinical assessments, health education, and utilization management services.
Provides assessments to individuals using telecommunications in accordance with computer-based algorithms, protocols, and guidelines.
Uses clinical knowledge to assess, disposition, make recommendations for care, provide education and health information.
Carenet Health values the expertise and dedication of their team members. They are committed to offering an appealing compensation package and creating an inclusive environment for all employees.
Administer assessments/screening tools to identify and prioritize member needs.
Develop individualized care plans and lead care coordination efforts.
Build strong, empathetic relationships with members, driving collaboration.
Tuesday Health is a value-based palliative care provider group dedicated to transforming serious illness and end-of-life care. They deliver goal-centered care focused on alleviating physical symptoms and emotional stress for individuals and their caregivers; through our leading-edge care model, Tuesday Health is shaping the future of community-based palliative care nationwide.
Provides telephonic assessments of members’ medical, psychosocial, physical and spiritual needs.
Develops, implements, and monitors person centered service plan and ensures continuity of care across all healthcare settings.
Educates members on disease processes, preventative health, and quality of life interventions.
MJHS is a supportive community committed to excellence, respect, and providing high-quality, personalized health care services. They foster collaboration, celebrate achievements, and promote fairness for all with comprehensive compensation and benefits.
Deliver coordinated, family-centered virtual Care Management by phone that improves behavioral health outcomes.
Develop personalized, goal-oriented care plans in collaboration with families and the multidisciplinary team.
Support members through behavioral health treatment plans, transitions of care, and episodes of acute behavioral health crises.
Included Health is a healthcare company that delivers integrated virtual care and navigation. They aim to raise the standard of healthcare for everyone by breaking down barriers to provide high-quality care for every person, offering care guidance, advocacy, and access to personalized virtual and in-person care.
Answer and triage after-hours calls across Ohio markets.
Conduct remote clinical assessments to determine patient and family needs.
Evaluate patient status changes and provide symptom management guidance.
Luminary Hospice is a mission-driven organization that empowers its team members to shape the culture and provide high-quality support to patients and families during their end-of-life journey. They are centered on caring for the whole person, providing expert medical care, pain management, and emotional and spiritual support to families and caregivers.
Provide timely, high-quality clinical recommendations grounded in evidence-based practice.
Effectively communicate assessment findings and provide advice to the in-center team.
Provide input into resident care plans in collaboration with the in-center team.
Summerset is the second largest retirement village operator in New Zealand, passionately dedicated to providing quality service to its clients. They are growing quickly, with 39+ villages, and proud of their dynamic work environment and diverse workforce.
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.