Perform clinical reviews to evaluate medical necessity, level of care, and benefit coverage for members.
Apply internal policies, MCG, and NCCN guidelines to deliver timely and compliant utilization management decisions.
Escalate complex cases and build audit-ready documentation for Medical Director review.
Personify Health created the first and only personalized health platform, bringing health plan administration, holistic wellbeing solutions, and comprehensive care navigation together in one place. Their mission-driven culture empowers diverse perspectives to drive real impact on people's health.
Complete individualized patient care plans and perform care management and coordination using our electronic medical record system.
Maintain frequent contact with patients to provide care coordination, support, and manage compliance with care management programs.
Document all client communications accurately and notify primary care clinicians regarding patient needs and emergencies.
We are a mobile primary care, palliative care, and hospice service provider with patients across multiple states. We offer programs including remote patient monitoring and chronic care management, and we seek individuals driven to make a difference who embody our motto, 'To Care is an Honor.'
Manage and triage patient vital signs remotely, using motivational interviewing to drive positive health behavior changes.
Perform monthly wellness calls with patients, collaborating with care teams to set patient-centric goals.
Escalate urgent care needs appropriately and meet program engagement metrics in a remote MST-based role.
Vivo Care is building a future where care is continuous, personal, and connected, challenging the status quo in healthcare. We are a fast-growing startup where everyone has a voice, fostering a culture of inclusion, collaboration, and innovation.
Conduct clinical reviews of inpatient admissions and continued stays using approved medical necessity criteria.
Collaborate with physicians, care managers, and payer teams to resolve utilization concerns and prevent denials.
Support quality improvement initiatives, maintain accurate documentation, and communicate review outcomes effectively.
This role is with a partner company focused on healthcare utilization management, helping hospitals improve patient outcomes and ensure appropriate resource use. The team operates as a distributed remote group supporting care coordination, revenue integrity, and clinical compliance.
Audit skilled nursing facility (SNF) medical claims for medically appropriate services using applicable guidelines and policies.
Document findings, generate audit letters, and support audit findings during the appeals process.
Work collaboratively with the audit team, clients, and contractors to improve medical policies and audit workflows.
Machinify is a healthcare intelligence company with expertise across the payment continuum, delivering value, transparency, and efficiency to health plan clients. Deployed by over 85 health plans representing more than 270 million lives, the company combines an AI-powered platform with best-in-class expertise to drive down healthcare costs.
Conduct monthly clinical check-ins and structured symptom assessments for assigned patient panels.
Collaborate with providers to escalate clinical concerns and reinforce care plans.
Maintain accurate documentation across EHR and CCM platforms while meeting quality metrics.
Evergreen Nephrology partners with nephrologists to transform kidney care through a value-based, person-centered, and holistic approach. The company thrives on innovation and evolution, with a culture that embraces change and focuses on improving patient outcomes.
Perform concurrent medical record reviews on nursing units to clarify patient documentation.
Prompt physicians to resolve missing, unclear, or conflicting documentation for appropriate reimbursement.
Provide education to patient care providers on clinical documentation standards and coding requirements.
Virginia Mason Franciscan Health provides a full spectrum of health care services across the Puget Sound region, with a legacy of compassionate care and innovation. With 10 hospitals and nearly 300 care sites, the organization is dedicated to healing the whole person through rigorous research, education, and collaboration.
Analyze and summarize medical records, highlighting relevant clinical findings for attorneys.
Prepare medical chronologies and long-term care assessments to support case evaluations.
Provide objective, evidence-based medical insights and coordinate with expert witnesses.
The partner company provides specialized legal nurse consulting services to attorneys, analyzing medical records and supporting injury-related cases. This role offers flexible, part-time contract work in a fully remote environment.
Evaluate AI-generated clinical interactions for accuracy, safety, and appropriateness.
Annotate and score AI responses against evidence-based protocols and structured rubrics.
Provide detailed written feedback and participate in calibration sessions to enhance AI reliability.
The company focuses on improving AI-powered clinical solutions by leveraging clinical expertise. It is an early-stage partner organization offering flexible, remote contract opportunities for healthcare professionals.
Manage patient messages through the telehealth platform and address routine clinical questions within your nursing scope.
Escalate complex medical concerns, coordinate with providers, and ensure timely follow-ups.
Maintain accurate documentation, follow HIPAA protocols, and work independently in a fast-paced remote environment.
LumiMeds is a fast-growing U.S.-based telehealth startup focused on weight management and long-term metabolic health. It is an early-stage, remote-first company with a globally distributed team that values clarity, accountability, and initiative.
Coordinate interdisciplinary care plans and serve as a liaison between patients, providers, and insurance partners.
Provide telephonic nursing triage, health guidance, and on-call support according to agency protocols.
Manage lab results, referrals, prescription refills, and patient follow-up to ensure continuity of care.
Planned Parenthood of the Pacific Southwest provides sexual and reproductive healthcare across 20 health centers in Southern California. The organization fosters a collaborative, mission-driven culture with over 100 years of advocacy.
Conduct clinical and billing reviews of claims, itemized bills, and UB-04 forms to ensure accuracy.
Perform utilization reviews to assess medical necessity and validate charges against policies.
Mentor reviewers, meet productivity targets, and maintain active RN licensure with CEUs.
Our partner is a healthcare services company that conducts medical claims and utilization reviews to ensure accurate billing and appropriate care. They offer a collaborative, quality-focused remote environment with opportunities for professional development.
Review and verify credentialing documents, licenses, and background reports against client-specific standards.
Collaborate with onboarding teams to ensure files are accurate, complete, and ready for approval.
Monitor document trends and support continuous improvement to reduce errors and enhance efficiency.
This company provides healthcare staffing services with a focus on clinician credentialing and onboarding. While the company size is not specified, it fosters a collaborative, service-oriented culture emphasizing accuracy and compliance.
Review inpatient medical records to validate DRG coding accuracy.
Apply clinical judgment to identify discrepancies, coding errors, and overpayments.
Document evidence-based audit findings and meet quality standards.
The company specializes in healthcare claims auditing and analytics, improving accuracy and consistency in payments. It is a collaborative, fully remote environment that values precision, teamwork, and continuous improvement.
Administer and track OSHA respiratory protection medical evaluations and N95 fit-testing.
Manage Hepatitis B and TB screening compliance, vaccination, and surveillance programs.
Maintain employee health records, compliance dashboards, and onboarding clearances.
DocGo provides mobile health services, remote patient monitoring, and ambulance services through an AI-powered logistics network. They have over 5,000 certified health professionals and focus on bringing affordable care to patients wherever they need it.
Provide after-hours triage, clinical assessment, and interventions via phone for patients and families.
Coordinate care by collaborating with physicians, facilities, and vendors to ensure positive outcomes.
Document all interactions in EMR and review team documentation for accuracy and compliance.
Moments Hospice provides compassionate end-of-life care and support to patients and families. It is a hospice organization with a supportive culture that offers ongoing training and advancement opportunities.
Receive and respond to prescription refill requests via phone, email, fax, and Telephone Encounter.
Verify prescription refill accuracy and compliance with regulatory guidelines.
Provide exceptional customer service and collaborate with interdisciplinary teams to optimize workflow.
Carenet Health provides healthcare support services, fostering collaboration and innovation. They are a market-leading remote team committed to employee growth and accountability.
Review lab results issued through Maple and assign appropriate follow-up recommendations for patients.
Contact patients directly when critical results require immediate emergency care and escalate complex cases to physicians.
Support specialist referrals, prepare documentation, and review consult reports to ensure timely follow-up.
Maple is Canada's leading on-demand healthcare platform, connecting patients with Canadian-licensed doctors, nurse practitioners and specialists. With over 8 million patients and 7,000 business and government partners, Maple empowers bold thinking and an inspiring team culture focused on making an impact.
Provide virtual, remote diagnostic care for after-hours and weekend clinical calls.
Assess, diagnose, treat, and document patients' physical and psychosocial health status.
Collaborate with physicians and care teams to ensure safe, high-quality telehealth outcomes.
ChenMed is a family-owned, physician-led primary care provider transforming healthcare for seniors. The growing, family-oriented team emphasizes compassion, innovation, and superior patient outcomes.
You perform complex medication reconciliations and identify clinical red flags to prevent ER visits and readmissions.
You deliver high-touch engagement for high-risk patients through post-discharge follow-up and care coordination.
You collaborate with practices and document interventions across multiple EHRs to ensure care gaps are closed.
Aledade PBC is a public benefit corporation that empowers independent primary care by creating value-based contracts. Founded in 2014, we are the largest network of independent primary care in the country, with a remote-first culture that is collaborative and inclusive.