Review clinical information to meet Medical Necessity Criteria.
Requires knowledge of managed care contracting and clinical review requirements.
Ensures accurate information is entered into claims system.
Sentara Health is a not-for-profit integrated healthcare provider based in Virginia and Northeastern North Carolina that has been in business for over 131 years. It has close to a 30,000-member workforce, and diversity, inclusion, and belonging is a guiding principle of the organization.
Responsible for the coordination of services for members meeting established criteria, emphasizing education/self-management and promoting quality care and cost-effective outcomes.\n- Uses a collaborative process to assess Member needs, review options for services and resources, develop and implement a plan of care, coordinate resources, monitor progress, and evaluate Member status.\n- Addresses medical, psychosocial, clinical needs, and behavioral health needs including members with mental health and substance use disorder needs, providing counseling and referrals to community/local/state programs.
Capital Blue Cross is committed to providing excellent service to both its team and the community. Employees have consistently voted it as one of the “Best Places to Work in PA”, which indicates a positive and supportive company culture.
Work as a member of the behavioral health team to expand organizational support.
Provide culturally appropriate health education and utilize critical thinking to navigate systems.
Facilitate the coordination of care and community resources to meet the patient's plan.
Southcoast Health is a not-for-profit health system with hospitals, clinics, and facilities throughout Southeastern Massachusetts and Rhode Island. They are committed to providing ethical workplaces where caregivers offer comprehensive healthcare close to home.
Providing group-based intervention and case management to members with Substance Use Disorders (SUD).
Excels at group facilitation on SUD-related topics with and without standardized curriculum.
Managing member communication over chat, email, and phone in a way that embodies the company mission and values.
Workit Health is an industry-leading provider of on-demand, evidence-based telemedicine care. Their programs are based in harm reduction, and bring together licensed clinicians, FDA-approved medication, online recovery groups and community, interactive therapeutic courses, and care for co-existing conditions. Workit Health is dedicated and passionate about their mission of making exceptional, judgment-free care for addiction more accessible.
Provide counseling to members on a weekly basis through text-based chat, video calls, and phone calls, to monitor their progress on their recovery journey
Onboard the users with an initial phone call and complete a multidimensional assessment to gather relevant behavioral health history and symptoms
Monitor the progress of members and offer therapeutic strategies on how to deal with temptations and cravings
Pelago is the world’s leading virtual clinic for Substance Use Management, providing guidance, support and treatment for members seeking to overcome their tobacco, alcohol and opioid use. They have scaled to helping hundreds of employers and health plans and has already helped more than 750,000 members manage their substance use better.
Provides exceptional patient-centered care, in a manner that ensures compliance with current PPNNE efficiency and productivity standards.
Assesses patient's health status and prescribes appropriate contraceptive methods, treatments for GYN problems.
Counsels/educates patients regarding general reproductive health care; all FDA-approved methods of birth control, including emergency contraception; pregnancy options including abortion, adoption as well as Gender Affirming Hormone Therapy.
Planned Parenthood of Northern New England (PPNNE) was founded on the belief that everyone has the fundamental right to make decisions about their bodies and reproductive futures free from harassment or fear. Joining Planned Parenthood means becoming part of a mission-driven movement, where your work will help make sexual and reproductive health care more accessible to all.
Maintain Managed Medicaid channel growth through continued development of relationships.
Support health plan and agency partners with successful Medically Tailored Meal programs.
Have a relationship-oriented approach to client engagements.
Mom’s Meals is a home-delivered meal service providing fully prepared, refrigerated meal solutions direct to homes nationwide for over 25 years. They are a family operated business looking for fun, compassionate, and friendly people who want to make a difference in the lives of others.
Provide empathetic, structured support to callers seeking help for substance use and related needs; de-escalate and maintain rapport.
Conduct clinical intakes using Scope, following Akido protocols, scripts, and decision support.
Connect callers to the right level of care (MAT access, outpatient, detox/residential referrals, counseling, harm-reduction services, basic needs).
Akido builds AI-powered doctors. It is the first AI-native care provider, combining cutting-edge technology with a nationwide medical network. They serve 500K+ patients across California, Rhode Island, and New York.
Monitor high-risk pediatric patients, ensuring appropriate follow-up and clinical management, and adjusting care plans as needed.
Conduct biopsychosocial assessments to address behavioral, social, emotional, and systemic needs of the patient and family.
Create and evaluate the effectiveness of the patient/family’s care plan and modify based on families evolving needs and goal progression.
Imagine Pediatrics is a tech-enabled, pediatrician-led medical group that reimagines care for children with special health care needs. They deliver 24/7 virtual-first and in-home medical, behavioral, and social care, working alongside families, providers, and health plans.
Assist with coordination and delivery of Extension health programs.
Develop and disseminate health communication materials.
Support community outreach efforts by assisting with event planning.
Utah State University is Utah’s premier land-grant, public service university. As an R1 research institution, Utah State is dedicated to advancing knowledge and serving the public good through innovative research and scholarly activities. USU enrolls over 29,800 students and is dedicated to fostering a community where all individuals feel respected, valued, and supported.
Build trusting relationships with patients, families, and providers, addressing health questions and care needs.
Identify medical, behavioral, social, emotional, and financial needs to support whole‑person care.
Strengthen the connection between patients and healthcare providers by addressing barriers and facilitating communication.
Guidehealth is a data-powered, performance-driven healthcare company dedicated to operational excellence, with the goal to make great healthcare affordable, improve patient health, and restore fulfillment for providers. They leverage remotely-embedded Healthguides™ and a centralized Managed Service Organization to build stronger connections with patients and providers.
Provide personalized coaching through text messaging using our digital tools.
Support clients dealing with burnout, anxiety, relationship challenges, and other behavioral difficulties.
Guide users by tailoring in-app content and recommending relevant services.
Liven is a self-discovery platform that helps people better understand themselves and transform their lives. They empower coaches to build and grow their private practice without administrative work, connecting them with engaged clients and providing advanced digital tools.
Serve as the client liaison for all incoming intake calls to the organization in a welcoming, energetic manner.
Demonstrate knowledge of organizational structure and criteria to clients, providing educated answers to clinical questions.
Initiate client Biopsychosocial Assessment by utilizing motivational interviewing techniques and schedule initial intake appointment utilizing EMR.
Groups Recover Together was founded in 2014 to make treatment for opioid addiction respectful, accessible, and affordable. They empower their members to regain control of their lives through a combination of community support, outpatient weekly group therapy and medication.
Provide individual and group therapy sessions for patients with substance use disorders, both in-person and via telehealth.
Conduct biopsychosocial assessments and develop treatment and discharge plans aligned with IOP level-of-care requirements.
Utilize evidence-based therapeutic modalities, such as CBT, MI, and DBT, to support patient recovery.
Steadfast Health aims to revolutionize substance use disorder (SUD) care by providing accessible, high-quality care. Recognizing the individuality of each recovery journey, they offer patient-centered, evidence-based therapies with unwavering support in a compassionate environment.
Help guide the patient through the abortion care system and work to overcome obstacles faced by the patient receiving the care and services they require.
Help patients identify needs and connect patients to appropriate resources and supports, coordinating with outside entities as well.
Help patients plan and book trips including but not limited to arranging and booking flights, bus, train, rideshares and making reservations for overnight accommodations.
Clinical Health Network for Transformation (CHN) supports Planned Parenthood's mission to bring high-quality, affordable care to every member of our communities. They are a collaboration between Planned Parenthood affiliates across the United States committed to advancing health equity.
Evaluates certification requests by reviewing the group specific requirements.
Triage the call to determine if a Utilization Review Nurse is needed to complete the call.
Cottingham & Butler sells a promise to help their clients through life’s toughest moments. Their culture is guided by the theme of “better every day” constantly pushing themselves to be better than yesterday.
Provides after hours support to members and leaders seeking services.
Problem-solves and assists with high touch and escalated/sensitive calls.
Spring Health is on a mission to revolutionize mental healthcare by removing every barrier that prevents people from getting the help they need, when they need it. They partner with over 450 companies, from startups to multinational Fortune 500 corporations, providing care for 10 million people.