Source Job

• Authorizes and reviews utilization of mental health and substance abuse services.
• Collects and analyzes utilization data and assists with discharge planning and care coordination.
• Provides member assistance with mental health and substance abuse issues, and participates in quality improvement projects.

Magellan Health, Inc. is committed to making a difference in the healthcare industry and communities. They value professional growth and development, total health and wellness, rewards and recognition, as well as employee unity, offering a place where you can thrive.

• Provide clinical services to patients.
• Work with adult, child, and/or adolescent populations.
• Maintain full licensure and credentials in Washington (LMHC, LCSW, LMFT).

LifeStance Health, Inc. is looking to hire talented therapists in Washington State, who are passionate about patient care and committed to clinical excellence.

• Work remotely to enhance member management and navigate the healthcare system.
• Promote wellness and assist members in achieving their healthcare goals.
• Conduct telephonic outreach, data analysis, clinical review, and documentation.

Guidehealth is a data-powered, performance-driven healthcare company dedicated to operational excellence, improving patient health, and restoring provider fulfillment.

• Manages client denials and concerns through analytic review of clinical documentation.
• Delivers final determination based on skillsets and partnerships with Humana parties.
• Investigates and resolves member and practitioner issues via phone or face to face to support quality goals.

Humana Inc. is committed to putting health first for teammates, customers, and the company. Through Humana insurance services and CenterWell healthcare services, they strive to make it easier for millions to achieve their best health, delivering needed care and service.

• Coordinate the delivery of medical equipment and verify order details.
• Troubleshoot patient issues regarding equipment delivery or usage.
• Collaborate with internal teams to ensure timely resolution of patient concerns.

This position is posted by Jobgether on behalf of a partner company.

• Ensure adherence to payer requirements and internal compliance standards.
• Support audit readiness, reduce denials, and improve claim resolution.
• Maintain payer setup and readiness including fee schedules.

Expressable is a virtual speech therapy practice on a mission to transform care delivery and expand access to high-quality services, serving thousands of clients.

• Evaluate denied Medicare primary insurance claims efficiently.
• Appeal denied claims through Redetermination, Reconsideration, or Administrative Law Judge processes, following laws.
• Proactively investigate patient charts by reading documents and conduct computer-based research.

Solventum is a new healthcare company with a history of tackling major challenges to improve lives and support healthcare professionals. They focus on innovative solutions at the intersection of health, material, and data science and are guided by empathy and clinical intelligence.

• Answer incoming inquiries from patients, answer questions, and schedule appointments
• Make outbound phone calls to patients, pharmacies, and insurance companies
• Create and triage tickets in ServiceNow

Talkiatry transforms psychiatry with accessible, human, and responsible care. They’re a national mental health practice co-founded by a patient and a triple-board-certified psychiatrist to solve the problems both groups face in accessing and providing the highest quality treatment.

Perform pre-call analysis and check the status by calling the payer or using IVR or web portal services. Maintain adequate documentation on the client software to send the necessary documentation to insurance companies. Comply with all reimbursement and billing procedures for regulatory, third party, and insurance compliance norms.

You’ll help connect providers, patients and communities with innovative solutions that create real value by supporting both the financial and clinical sides.

• Ensuring providers are credentialed in a timely manner by monitoring the submission process.
• Monitoring submission processes, updating protocols, and managing Virtual Assistants/BPO.
• Communicating with payors and conducting regular reviews to validate internal credentialing data.

Grow Therapy aims to be the trusted partner for therapists growing their practice, and patients accessing high-quality care. They are a three-sided marketplace that empowers providers, augments insurance payors, and serves patients and have empowered more than ten thousand therapists.

• Provides support in the functional areas of the Revenue Cycle, including Billing, Reimbursement, and Insurance Recovery.
• Ensures adherence to company policies, procedures, and related government regulations.
• Prepares and submits claims to various insurance companies electronically or on paper.

At St. Luke’s, we pride ourselves on fostering a workplace culture that values diversity, promotes collaboration, and prioritizes employee well-being.

• Complete biopsychosocial assessments.
• Provide individual and group therapy.
• Collaborate with team to coordinate care across various substance use treatment settings.

Mindoula Health is seeking a Florida-licensed Therapist to remotely support members in our Substance Use Disorder Program, which focuses on prenatal and postpartum care.

• Serve as the first point of contact for patients, resolving questions and concerns across multiple platforms.
• Troubleshoot technical issues related to the website, patient accounts, and internal tools.
• Maintain security and confidentiality at all times, adhering to HIPAA and other regulations.

Thirty Madison is a family of specialized healthcare brands devoted to creating exceptional outcomes for all, with brands focused on specific conditions.

• Provides policy expertise related to systems or products.
• Communicates Medicaid program insight to UX researchers and designers.
• Analyzes laws and policy documents and explains their impact.

A1M Solutions is a woman-owned small business focused on providing value to customers, employees, partners, and the community, while remaining aligned to its guiding principles. A1M’s mission is to preserve and improve government healthcare programs for underserved people in the United States, focusing on projects with nation-wide impact at the intersection of policy, data, and user experience design.

• Process incoming and outgoing transfer requests, verifying all patient and prescription data.
• Coordinate patient profiles with appropriate pharmacy support and services, providing an exceptional customer service experience each day.
• Perform claim adjudication and auditing duties such as prior authorizations, billing and eligibility checks.

AnewHealth is one of the nation’s leading pharmacy care management companies that specializes in caring for people with the most complex, chronic needs.

• Provide empathetic and solution-focused assistance through various channels.
• Drive member engagement from enrollment through program completion.
• Establish human connections with members and provide personalized support.

Sword Health is shifting healthcare from human-first to AI-first through its AI Care platform, making world-class healthcare available anytime, anywhere.

• Perform virtual remote counseling and psychotherapy.
• Determine and implement behavioral health treatment plans.
• Conduct monthly chart reviews as part of our peer review QA process.

Included Health 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 care.

• Manage schedules and provide administrative support.
• Review payroll and assist with benefits and timesheets.
• Support patient satisfaction and handle communications.

They operate a busy U.S.-based home care agency, providing support to patients and caregivers across various administrative and operational needs. The agency is seeking a reliable, detail-oriented, and compassionate Virtual Care Coordinator who can manage day-to-day communication and logistics.

• Maintain ongoing caseload of individuals through the utilization of evidence based approaches to promote engagement and achievement of health goals
• Use relationship-based strategies to support members with social support navigation, understanding that many may have lived personal experiences causing them to be initially hesitant or distrusting of the health care system
• Conducts periodic telephonic and SMS outreach to ensure timely follow-up to members

Pair Team is an innovative, mission-driven company reimagining how Medicaid and Medicare serves the most underserved populations. As a tech-enabled medical group, they deliver whole-person care - clinical, behavioral, and social - by partnering with organizations deeply connected to the communities they serve.

• Conduct remote Telepsychiatry outpatient visits.
• Develop individual care plans and provide therapeutic interventions.
• Provide consultation and health education support to patients and families.

TimelyCare specializes in providing telehealth services to higher education institutions, offering students access to medical and mental health care. They partner directly with colleges and universities to provide services without insurance hassles, focusing on a motivated student population.