Conduct medical necessity reviews and continued stay reviews using approved clinical criteria to support quality and financial outcomes.
Collaborate with liaisons, physicians, and revenue cycle teams to manage denials, appeals, and appropriate levels of care.
Maintain documentation, monitor utilization trends, and facilitate patient care planning across the care team.
Ensemble is a leading provider of technology-enabled revenue cycle management solutions for health systems, including hospitals and affiliated physician groups. They empower associates to challenge the status quo and put people first, fostering a collaborative and innovative culture.
Perform medical necessity and level of care reviews using clinical judgment and guidelines.
Obtain member information via telephone and fax to assess condition and apply evidence-based criteria.
Meet decision-making SLAs and refer members for further care engagement when needed.
Oscar Health is a technology-driven health insurance company focused on simplifying healthcare for its members. We are a mission-driven organization with a diverse team, committed to innovation and equity in healthcare.
Oversee system-level utilization management activities across the organization.
Ensure compliance with medical necessity criteria such as InterQual and Milliman.
Manage professional staff and review processes to optimize patient care.
Piedmont Healthcare is a healthcare system providing comprehensive medical services. It is a large organization focused on utilization management and quality care.
Deliver quality care to patients via phone and video as a supervising physician.
Provide direct oversight to nurse practitioners and physician assistants within state regulations.
Collaborate with MAs, RNs, and other providers across service lines.
Oscar Medical Group is a healthcare organization focused on delivering personalized care and refactoring the healthcare delivery system. They foster an innovative, inclusive culture where team members can be their most authentic selves.
Conduct comprehensive reviews of home health pre-claim review packages for Medicare compliance.
Document review outcomes with clinical rationale and meet a 7-business-day turnaround.
Maintain 98% accuracy and complete required training and quality assurance sessions.
Broadway Ventures is a consulting firm providing program management, technology, and innovative solutions to government and private sector clients. As an 8(a), HUBZone, and Service-Disabled Veteran-Owned Small Business, it emphasizes integrity, collaboration, and excellence in its culture.
Performs pre-admission, admission, and continued stay reviews using approved medical necessity criteria.
Coordinates patient care and communicates with physicians, patients, caregivers, and third-party payers.
Manages patient progression through the healthcare system and proactively works with payers to secure certification and minimize denials.
Ochsner Health is a leading not-for-profit healthcare provider in the Gulf South, with 46 hospitals and 370+ care centers. It employs more than 38,000 team members and has been recognized as a top workplace and the No. 1 hospital in Louisiana.
Performing timely utilization review of healthcare services using approved medical necessity criteria.
Collaborating with medical directors, providers, and internal teams for compliant review processes.
Ensuring accurate documentation and communication of determinations within regulatory timeframes.
Guidehealth is a data-powered, performance-driven healthcare company focused on making healthcare affordable and improving patient health. It is a physician-led organization using AI and predictive analytics, with a culture of accountability, growth, innovation, and empathy.
Provide remote medical oversight for patient treatment decisions.
Log in twice daily to review and approve treatment plans.
Must hold an active, unrestricted Georgia medical license.
Meds is a healthcare company that facilitates remote patient consultations and prescription management. The company operates with a small, distributed team and values flexibility and autonomy.
Provide remote medical consultations and prescribe treatments for patients in Ohio.
Log in twice daily to review and determine appropriate treatment plans.
Must hold a current unrestricted Ohio medical license.
Meds is a healthcare platform connecting patients with physicians for remote consultations. The company is a growing telemedicine provider with a focus on accessible care.
Perform prospective, concurrent, and retrospective reviews of healthcare services to ensure medical necessity and appropriate level of care.
Contact medical and support personnel to recommend alternative treatment plans and coordinate care across the healthcare continuum.
Research and resolve issues related to benefits, eligibility, and appeals while delivering targeted education to providers.
HealthEdge provides AI-powered operational infrastructure for health insurance companies, covering claims administration, payment integrity, and care management. The company is experiencing significant momentum and investing in employees who directly shape the future of healthcare technology.
Review and analyze Medicare claims sampled by the Department of Justice to determine correct coding and payment based on coverage and utilization.
Conduct in-depth claims analysis to detect fraudulent or abusive billing practices using ICD-10, CPT-4, and CMS guidelines.
Complete summary reports and communicate findings internally while maintaining confidentiality and compliance with DOJ and CMS regulations.
Empower AI provides AI-powered solutions for federal government agencies, helping them transform their workforce and operations. Headquartered in Reston, Va., the company has three decades of experience in Health, Defense, and Civilian missions and is recognized as a 2024 Military Friendly Employer.
Review OASIS documentation and plan of care to ensure compliance with regulations and accuracy.
Evaluate patient visit frequency and utilization to align with clinical needs and provider orders.
Collaborate with coding partners and escalate documentation improvement opportunities to leadership.
Graham Healthcare Group designs business and technology solutions to drive better care and outcomes in home health and hospice. As a subsidiary of a publicly traded company, they've been improving care coordination for over 20 years, focusing on patient-centered home care.
Review prior authorization cases to ensure clinical and operational standards are met.
Audit AI outputs, third-party reviews, and internal decisions for accuracy and compliance.
Collaborate cross-functionally to refine workflows and improve patient access to treatment.
Generator Health operates a platform that streamlines prior authorization processes for patients and providers. They handle tens of thousands of patients weekly and emphasize collaboration and accuracy in a high-autonomy remote environment.
Deliver direct patient care via telemedicine as part of a multidisciplinary team.
Supervise and support a team of Advanced Practice Providers, serving as a clinical escalation point.
Drive clinical guidelines and quality outcomes through collaboration with Operations and Product teams.
Oscar Health is a health insurance company built on a full-stack technology platform, focused on serving members with a member-centric approach. Founded in 2012, the company fosters a culture of belonging and support while working to transform healthcare.
Review patient charts twice daily to determine treatment appropriateness.
Must reside in Mississippi with an unrestricted medical license.
This is a contract, part-time remote position with flexible scheduling.
Meds is a healthcare platform connecting physicians with remote opportunities. The company offers flexible contract work for licensed physicians in a virtual setting.
Conduct comprehensive virtual assessments, diagnoses, and evidence-based treatment planning for primary care patients.
Manage chronic conditions, provide preventive care, and order diagnostic tests and lab results.
Use AI-powered clinical technology and EMR systems to deliver high-quality care in a fully remote setting.
Curai is a healthcare company that harnesses AI and clinical expertise to make care more affordable, accessible, and effective. They have a mission-driven team of talented colleagues committed to collaboration and driving meaningful impact.
Review medically complex claims, pre-authorization requests, appeals, and fraud/abuse referrals.
Assess payment determinations using clinical information and established coverage guidelines.
Educate teams on medical review processes and support quality control activities.
Broadway Ventures is a veteran-owned small business delivering mission-critical support to federal health and defense customers. As an 8(a), HUBZone, and Service-Disabled Veteran-Owned Small Business, it is built on integrity, collaboration, and excellence.
Deliver high-quality synchronous and asynchronous virtual care.
Perform comprehensive clinical assessments and prescribe medications safely.
Work 100% remotely with flexible scheduling and multiple telehealth opportunities.
Wheel Medical Group is a physician-owned professional corporation providing virtual care infrastructure for innovative companies across the United States. The company connects board-certified clinicians to telehealth brands through one platform, offering flexibility, clinical support, and malpractice coverage.
Conduct video-based appointments for non-emergency issues.
Treat patients in internal medicine and related areas such as urgent care, gynecology, and obesity care.
Design personalized treatment plans and collaborate remotely with other clinicians.
DrHouse is building a new model of virtual healthcare that is fast, accessible, and centered on both patient and provider experience. They are a growing digital health company with a mission-driven community of clinicians committed to equitable healthcare access.
Perform medical assessments, review patient histories, and provide recommendations or prescriptions.
Maintain accurate documentation of patient encounters in the electronic health record system.
9amHealth is an AI-enabled virtual specialty care platform focused on managing high-cost chronic conditions like obesity, diabetes, and hypertension. Founded in 2021 and backed by leading healthcare investors, the company fosters a collaborative learning culture with a small, flexible team spread across the globe.