Build meaningful relationships with patients and families to create personalized care plans addressing medical, behavioral, and social needs.
Coordinate care across providers and settings while educating and empowering members to navigate the healthcare system confidently.
Collaborate with an interdisciplinary team, using data for insight and maintaining compliance while prioritizing compassion and connection.
Guidehealth is a data-powered, performance-driven healthcare company using AI and predictive analytics to improve healthcare affordability and patient outcomes. It is a physician-led, fully remote organization with a collaborative, agile culture focused on innovation and empathy.
Oversee the Complex Clinical Bill Review team, managing production expectations, SLAs, client communication, and team performance.
Analyze and track internal business requirements, continuously evaluate functionality across programs, and perform requirements gathering to solve process issues.
Monitor team performance metrics, identify growth opportunities, and coordinate system enhancements including JIRA and UAT testing.
Machinify is a leading healthcare intelligence company providing an AI-powered platform for health plan clients. They are deployed by over 85 health plans, representing more than 270 million lives, with a culture of innovation and efficiency.
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.
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.
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.
Manage a defined patient caseload while overseeing the clinical performance and compliance of an assigned team of Care Managers.
Conduct proactive outreach, device data review, care plan updates, and care coordination consistent with team standards.
Lead client-facing engagements, performance reviews, and escalation calls, representing Welby Health with clinical authority.
Welby Health is a San Diego-based healthcare organization that transforms complex condition management through technology-enabled care coordination and data-driven insights. The company partners with physicians and health systems to deliver scalable solutions improving quality of care.
Coordinate and provide care that is timely, effective, and member-centric while following HMO processes.
Manage case assignments including outreach, documentation, monitoring for case progression, and case closure.
Assist members in reaching wellness by addressing barriers, social determinants, and psychosocial issues.
Guidehealth is a data-powered healthcare company dedicated to making great healthcare affordable and improving patient outcomes. It is a physician-led, performance-driven organization with a culture of empathy, accountability, and continuous learning.
Survey ambulatory care organizations across the United States within the scope of Joint Commission's Ambulatory Programs.
Engage health care staff in interactive dialogues to assess compliance and identify opportunities for improving care quality.
Prepare management reports that link standards deficiencies with systems vulnerabilities and communicate findings to leadership.
The Joint Commission accredits and certifies health care organizations to improve patient safety and quality of care. It employs a nationwide team of surveyors who work remotely and travel extensively.
Lead and support a remote clinical support team to ensure exceptional patient service and operational excellence.
Coach and mentor team members while overseeing performance, quality audits, and provider workflows.
Drive continuous improvement initiatives and maintain adherence to clinical and quality standards.
Ways2Well is redefining healthcare through regenerative and preventive medicine, offering data-driven personalized care. They operate as a remote clinical support team with a focus on high-impact healthcare and patient empowerment.
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.
Own daily outreach and enrollment performance, including call volume, reach rate, and enrollment numbers.
Lead and develop the enrollment team through direct supervision, coaching, and performance management.
Drive quality, compliance, and scalability of enrollment processes and documentation.
Vynca is a healthcare company focused on transforming care for individuals with complex needs, providing comprehensive care for more quality days at home. The company fosters a close-knit community culture guided by values of Excellence, Compassion, Curiosity, and Integrity.
Assess member needs across physical health, mental health, SUD, oral health, and social supports.
Develop and oversee client care plans, set SMART goals, and evaluate progress.
Coordinate with healthcare providers, connect clients to community services, and advocate on their behalf.
Vynca is a healthcare company dedicated to transforming care for individuals with complex needs, focusing on providing comprehensive care for more quality days at home. They are a close-knit community committed to core values of Excellence, Compassion, Curiosity, and Integrity, fostering an inclusive workplace.
Provide Utilization Review and Case Management to Emergency Department patients with social or discharge needs.
Offer hospital-wide Utilization Review and Case Management coverage as needed and time allows.
Hold a valid RN state licensure; 3-5 years of nursing experience preferred.
Freeman Health System is a not-for-profit health system serving communities across Missouri, Arkansas, Oklahoma, and Kansas through a network of hospitals, physician clinics, and specialty services. The system is supported by over 7,000 employees and is the only Children's Miracle Network Hospital in a 70-mile radius.
Develop, implement, and monitor outcome-based reporting systems for high-risk diagnoses, patient groups, and care processes.
Collaborate with interdisciplinary teams to prepare quality reports for clinical departments and regulatory bodies.
Apply performance improvement methods like Lean Six Sigma and Rapid Cycle PDSA to enhance patient care outcomes.
Cooper University Health Care is a leading healthcare provider committed to extraordinary care and clinical innovation. With a large team of professionals, it offers competitive benefits and opportunities for career growth.
Lead a remote team of RNs and LPNs managing real-time patient alerts in a high-volume triage environment.
Monitor queue metrics, conduct clinical audits, and provide coaching to ensure quality and operational targets.
Partner with leadership on workflow optimization, staffing, and contribute to direct patient care as needed.
Cadence is the clinical AI company automating the treatment of chronic disease with its Clinical Intelligence platform. They partner with over 20 leading health systems and serve a population of over 100,000 patients, recognized by TIME and LinkedIn as a top startup.
Own quality performance across all clinical tiers, including call and documentation quality for RNs, providers, and PSS Engagers, plus organization-wide clinical outcomes.
Lead and develop a team of Quality Reviewers, setting standards, conducting calibrations, and coaching to ensure consistent, defensible scoring.
Build and analyze quality dashboards and datasets to identify trends, root causes, and improvement opportunities, presenting findings to executive leadership.
CareTalk Health is a fully remote, nationwide virtual medical practice partnering with Medicare Advantage plans to deliver Annual Wellness Visits and close care gaps. We are a growing, collaborative team focused on making virtual care simple, reliable, and human.
Engages members proactively and reactively to build trust and drive benefit and program engagement through motivational interviewing.
Develops individualized care plans based on comprehensive clinical, psychosocial, and SDOH assessments, coordinating resources across the care continuum.
Educates members and providers on benefits, digital health solutions, and self-management strategies while supporting utilization review and documentation.
Evry Health is a digital-first health plan focused on delivering comprehensive, member-centered care coordination for its fully insured commercial population. The company operates as a fully remote team with headquarters in Dallas, Texas, emphasizing a technology-forward and collaborative culture.
Lead and supervise a team of nurses, medical assistants, and community health workers in a remote care coordination setting.
Coordinate clinical appointments, medication authorizations, and patient education for children with chronic conditions.
Ensure compliance with healthcare regulations and participate in quality improvement initiatives to optimize care delivery.
Clarity Pediatrics is a startup reimagining pediatric chronic care, starting with ADHD and expanding to obesity management. The leadership team has deep healthcare expertise, and the company fosters a remote, tech-enabled culture focused on clinical excellence.
Lead and support a virtual team of Transitions of Care Coordinators, providing day-to-day guidance and fostering a patient-focused environment.
Dedicate approximately 30% of your time to direct transitions-of-care patient support, coordinating appointments, transportation, and equipment.
Oversee team performance, develop workflows, and contribute to program development and cross-functional initiatives.
This organization partners with healthcare providers to support patient transitions from hospital to home. They operate with a virtual team and emphasize patient-centered care and professional growth.