Conduct coverage reviews and render determinations based on member benefits and medical policies.
Document clinical findings and actions in accordance with regulatory and accreditation requirements.
Engage in peer-to-peer discussions with providers and collaborate on benefit determinations.
Capital Blue Cross is a health insurance company that provides coverage and services. They are consistently voted as one of the Best Places to Work in Pennsylvania, reflecting a positive culture.
Lead the care, case, and utilization management programs, setting clinical direction and owning performance targets.
Evolve clinical operating models and partner with Product and Engineering to integrate AI tools into workflows.
Manage, develop, and retain clinical leaders while collaborating cross-functionally to coordinate care for members.
Included Health is a healthcare company delivering integrated virtual care and navigation. They are on a mission to raise the standard of healthcare for everyone, with a remote-first culture and a focus on breaking down barriers to high-quality care.
Lead care management programs with strategic and operational oversight.
Drive clinical performance metrics and evidence-based care models.
Collaborate with cross-functional teams to integrate AI and improve population health.
The partner company is a healthcare organization focused on care management and population health. It operates with a remote-first culture and offers opportunities to influence innovative healthcare models.
Lead clinical quality and compliance by auditing provider activity, providing feedback, and partnering with Legal, Compliance, and Patient Safety teams.
Manage and develop the Psychiatry Operations team, setting priorities, workflows, and performance expectations while fostering a culture of accountability.
Drive operational excellence through data-driven decisions, strategic initiatives, and collaboration with Product and Engineering on platform enhancements.
BetterHelp is on a mission to remove traditional barriers to therapy and make mental health care more accessible to everyone. Founded in 2013, we are now the world's largest online therapy service with a network of over 30,000 licensed therapists, and we deeply invest in our team's well-being and professional development.
Manage and coordinate a formal quality improvement program across a large network of crisis centers to achieve quality improvement goals.
Oversee internal QI activities, ensure adherence to funder and agency goals, and prepare reports for external stakeholders.
Collaborate with other departments to develop proactive QI activities and monitor performance to ensure compliance with operational and clinical KPIs.
Vibrant Emotional Health provides high-quality services and support for emotional wellness through technology-enabled services, community programs, and advocacy. For over 50 years, they have been at the forefront of promoting emotional well-being, with a focus on saving lives and supporting everyone in need.
Provides medical interpretation and clinical review for appropriateness of services, including Home Care Solutions, Skilled Nursing Facility, Durable Medical Equipment, rehabilitation, and discharge planning.
Advises executives on functional strategies related to OneHome initiatives and clinical priorities, exercising independent judgment on complex issues.
Ensures compliance with CMS guidelines, Medicare/Medicaid requirements, and Humana policies while supporting quality, utilization management, and care coordination.
Humana is a leading U.S. healthcare company providing insurance and healthcare services through its Humana insurance and CenterWell healthcare services. It is a large, publicly traded organization with a culture focused on the Humana Way, emphasizing collaboration, accountability, and improving member experiences.
Serve as lead clinician and engagement manager for complex care clients, collaborating with PhD scientists and care coordinators.
Utilize clinical expertise to assess key issues, identify top experts, and guide patients to optimized care plans.
Build strong client relationships and coordinate with external providers and internal teams to deliver personalized care.
Private Health Management guides patients and families through the chaos and complexity of serious medical care as an independent advocate. The company is a remote organization with team members across the United States, focused on delivering personalized, measurably better outcomes.
Lead clinical excellence managers in their region through account management and customer success.
Partner with customers to ensure highest standards of patient care and drive long-range sales plan.
Collaborate with cross-functional teams to align clinical strategies with company objectives.
Outset Medical is a trailblazing medical device company that is revolutionizing dialysis by pioneering groundbreaking technology. They focus on creating a high-performing team obsessed with progress in an atmosphere of transformative opportunities.
Provide clinical quality oversight and administrative supervision of up to 40 vIOP therapists.
Support recruiting, onboarding, training, and ongoing mentoring of therapists with evidence-based treatments.
Ensure culturally responsive, outcomes-driven care across the team and maintain a small personal caseload.
Lyra Health is a leading provider of evidence-based mental health care, serving over 20 million people globally through employer and health plan partnerships. The company has delivered more than 15 million sessions of mental health care and published over 35 peer-reviewed studies, fostering a culture of innovation and clinical excellence.
Leverage your experience as a Practice Manager or Clinic Nurse to assist physician offices in improving quality initiatives.
Implement clinical quality improvement activities and generate reports from electronic health records to identify care gaps.
Provide process improvement interventions and educational support to close gaps in day-to-day workflows.
Health Services Advisory Group (HSAG) transforms healthcare delivery in the United States through quality improvement initiatives. As a growing team, they focus on improving the quality of healthcare for communities across multiple states and territories.
Lead clinical quality, quality improvement, and risk adjustment programs in a managed care environment.
Analyze performance data to identify trends, gaps, and opportunities for improved care and cost reduction.
Provide people leadership, coaching, and development to clinical and quality team members.
Our partner is a healthcare organization focused on improving access, quality, and outcomes. They operate in a managed care environment with a collaborative, purpose-driven culture.
Provide leadership and operational oversight for a team of Behavioral Health Care Managers delivering brief therapeutic interventions in the Collaborative Care Model.
Ensure high-quality, evidence-based behavioral health interventions and coordinate with psychiatric consultants and oncology clinics.
Optimize patient outcomes in alignment with organizational and regulatory standards.
Colla Health helps people with cancer improve their quality of life by providing behavioral healthcare as an extension of their medical treatment. They are backed by a premier venture capital firm and are building a world-class team of clinicians, technologists, and healthcare operations builders.
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.