Review and complete disability and leave documentation for patients.
Communicate with healthcare providers to gather required medical information.
Ensure compliance with HIPAA and manage multiple cases independently.
The company provides innovative healthcare technology solutions that streamline patient documentation. It operates remotely with a focus on accuracy, service, and operational excellence, though team size is not specified.
Provide telephonic case management to proactively drive return to work.
Perform utilization review and coordinate care with providers and adjusters.
Evaluate treatment plans and partner with adjusters to achieve optimal outcomes.
AmTrust Financial Services is a fast-growing commercial insurance company providing comprehensive telephonic case management. They foster a diverse and inclusive culture with a focus on attracting and retaining the best talent.
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 individualized clinical education, treatment-support services, and care coordination for patients in remote patient nutrition support and adherence programs.
Conduct structured outreach, identify barriers to treatment adherence, and develop practical strategies within program scope.
Document patient interactions, escalate clinical concerns per protocols, and collaborate with cross-functional teams.
PRO-spectus is a supportive, dedicated, and teamwork-driven company focused on improving the lives of patients they support. They have a culture that celebrates personal and professional accomplishments with humility and compassion.
Manage client medical payment policies to ensure accuracy and compliance with CMS and payer guidelines.
Conduct periodic reviews and analyses of policy updates, coordinating with Medical Directors and presenting recommendations to clients.
Serve as the primary client liaison, addressing inquiries and maintaining detailed documentation of policy nuances.
Cotiviti is a healthcare data analytics company specializing in payment accuracy and medical policy management. The company fosters a collaborative remote culture and offers competitive benefits to support its team.
Perform clinical reviews and conduct peer-to-peer discussions.
Participate in inter-rater reliability activities and clinical rounds.
Serve as a clinical resource and subject matter expert to clinical and non-clinical staff.
Devoted Health is a healthcare company that aims to improve the health and well-being of older Americans through a data and AI-driven care platform. The company values diversity, collaboration, and a supportive work environment, and is an equal opportunity employer.
Review and evaluate electronic medical records of emergency department admissions to screen for medical necessity using InterQual or MCG criteria.
Apply evidence-based clinical guidelines to assess and ensure proper utilization of healthcare resources.
Enter clinical review information into the system for transmission to insurance companies for authorization.
Netsmart provides advanced healthcare technology solutions for post-acute and human services clients, enabling better care through a comprehensive platform. We are a vision-driven team passionate about innovation, and we have been recognized as one of the best companies to work for.
Conduct in-depth interviews encompassing lifestyle and medical questions to facilitate the underwriting process for insurance clients.
Utilize excellent interpersonal skills and tact when eliciting personal and medical information.
Manage workload efficiently with strong organization and time-management skills while respecting confidentiality.
Manulife is a leading international financial services provider that helps people make decisions easier and lives better. As a global company with a large workforce, they foster an inclusive work environment and are committed to diversity and employee well-being.
Review prospective admissions against approved criteria and schedule assessments for voluntary patients.
Respond promptly to inquiry calls and manage clerical duties including paperwork and data entry.
Coordinate with referral sources and arrange transportation for patients to ensure smooth admissions.
White Deer Run provides mental health and substance abuse treatment services. The organization values compassion and patient safety, operating with a focus on guiding patients through the admissions process.
Partners with customers, care partners, SLPs, and referral sources throughout the AAC evaluation and acquisition process.
Conducts clinical consultations to assess communication needs and recommend appropriate AAC solutions using consultative sales techniques.
Collaborates with SLPs to facilitate evaluations, documentation, and maintain accurate customer records within company systems.
Lingraphica is a mission-driven organization that provides speech-generating devices to improve communication for people with aphasia and other speech impairments. They are a leader in AAC technology, look for candidates who enjoy a fast-paced, goal-oriented environment, and share their commitment to helping individuals on their communication journey.
Eligibility Review: Review patient records and clinical documentation to determine eligibility for Form Health.
Record Collection: Manage requesting, faxing, and tracking medical records from external providers while ensuring HIPAA compliance.
File Communication: Maintain clear communication with patients and colleagues to keep them updated throughout the eligibility process.
Form Health is a virtual obesity medicine clinic that provides multi-disciplinary evidence-based obesity treatment through telemedicine. Founded in 2019, it is a venture-backed startup with an experienced clinical and leadership team, committed to a culture of inclusion and patient-first values.
Perform prospective, concurrent, and retrospective utilization reviews for behavioral health services across multiple care settings.
Assess medical necessity and coordinate care with providers, members, and internal teams to ensure appropriate access and treatment.
Support discharge planning, benefit utilization, and regulatory compliance while improving overall care quality.
This company provides high-quality behavioral health coordination and utilization management services to improve member outcomes. They foster a supportive, collaborative environment focused on professional growth and clinical excellence.
Support the Care Advice Line call queue after hours, weekends, and holidays, answering calls promptly and accurately.
Triage and transfer calls to RNs, providers, or 911 as needed, while charting in EMR and maintaining patient communications.
Provide patient education, referrals, and scheduling assistance to support care coordination and proactive health management.
Privia Health is a technology-driven national physician enablement company that collaborates with medical groups, health plans, and health systems to optimize physician practices and improve patient experiences. The company is led by top industry talent and physician leadership, focusing on reducing healthcare costs and improving outcomes.
Supervise daily operations of clinical compliance auditors and specialists.
Assist in developing coordinated team processes and managing UM and PHM plan adherence.
Serve as clinical services liaison to senior management and ensure timely documentation.
Guidehealth is a data-powered healthcare company focused on operational excellence and value-based care. They emphasize empathy, AI, and collaboration, with a remote-first culture.
Engage with members by phone to encourage participation in care management programs and complete non-clinical assessments.
Identify barriers to care and connect members with appropriate services, benefits, and community resources.
Accurately document member interactions and operate effectively in a high-volume, remote call-center environment.
This partner company helps members navigate care management programs and access resources to improve their health and well-being. It operates remotely with a focus on compassionate support and efficient operations, though specific size and culture details are not mentioned.
Care for patients in individual visits to address their mental health needs and concerns.
Screen for unmet care needs, including clinical or medication issues, behavioral concerns, safety risks, and psychosocial well-being.
Establish trusting relationships with patients and their caregivers using active listening and empathy.
Daymark Health is a value-based oncology company redefining the cancer care experience for patients, providers, and health plans. It is backed by several venture funds and led by CEO Dr. Justin Bekelman, a pioneer in transforming cancer care.
Assist clinicians with gathering medical information for patients in between visits using various electronic health record systems.
Report medical concerns monthly such as falls, medications, behavioral issues, and hospitalizations.
Complete PCM interventions each month for approximately 15 patients per day.
MTC Care is the nation's leading telemedicine provider of behavioral health care to skilled nursing and assisted living facilities. They are an equal opportunity employer committed to fostering an inclusive workplace.
Handle inbound calls from patients, attorneys, and insurance providers to resolve billing-related issues.
Communicate revenue cycle processes and insurance information clearly to ensure positive customer experiences.
Apply knowledge of healthcare insurance terminology and payer requirements to support accurate responses.
The company is a healthcare services organization that provides patient support and revenue cycle management services. It fosters a patient-focused, remote work culture with an emphasis on empathy and professionalism.
Connect with customers via phone, email, chat, and social media to resolve their questions or concerns.
Calmly de-escalate issues and escalate interactions when necessary.
Track all call-related information for auditing and reporting purposes.
TP is a global digital business services company that delivers advanced, digitally powered business services to help brands streamline their business. With over 500,000 employees speaking 300+ languages, they foster an inclusive and diverse culture.
Implements and supports the philosophy, mission, values, standards, policies, and procedures of The Ohio State University Wexner Medical Center.
Functions within the multidisciplinary team to secure complex pre-authorizations and prevent/appeal clinical denials.
Utilizes clinical knowledge to interpret and apply medical necessity guidelines to determine appropriateness for services provided.
The Ohio State University is a top-20 public university with one of America’s leading academic health centers. They are a team of dedicated colleagues with access to boundless resources.