Prepare prior authorization requests by validating prescriber and member information and ensuring appropriate clinical guidelines.
Make outbound calls to providers to obtain additional clinical information for pharmacist review.
Review and analyze pharmacy claims data for proactive outreach and intervention.
Judi Health is an enterprise health technology company offering pharmacy benefit management and health benefit solutions for employers and health plans. They are a startup focused on rebuilding trust in healthcare in the U.S.
Perform clinical reviews and conduct peer-to-peer discussions.
Participate in inter-rater reliability activities and clinical rounds.
Serve as a clinical resource and subject matter expert to clinical and non-clinical staff.
Devoted Health is a healthcare company that aims to improve the health and well-being of older Americans through a data and AI-driven care platform. The company values diversity, collaboration, and a supportive work environment, and is an equal opportunity employer.
Perform clinical reviews for medical necessity, level of care, and authorization-related denials.
Review inpatient and outpatient medical records to support appeal submissions and apply payer-specific guidelines.
Document review findings accurately and meet assigned turnaround times while maintaining quality standards.
CorroHealth helps clients exceed their financial health goals by providing scalable solutions and clinical expertise across the reimbursement cycle. The company fosters a supportive culture that invests in professional development and personal growth.
Serve as the senior clinical authority, developing and refining clinical protocols for weight management.
Recruit, onboard, and supervise providers, ensuring compliance with telehealth and prescribing regulations.
Monitor clinical outcomes, embed safety checks, and report key metrics to leadership.
LumiMeds is a fast-growing U.S.-based telehealth startup focused on weight management and long-term metabolic health. As a remote-first, early-stage company, we operate with limited layers, expect high ownership, and value clarity, accountability, and initiative.
Perform medical intakes and prescribe buprenorphine/naloxone for new members in early treatment.
Provide longitudinal maintenance care to a panel of members and cross-coverage for colleagues.
Collaborate with medical leadership to develop new service lines and support provider training.
Groups is a healthcare organization providing recovery services for individuals with substance use disorders, leveraging telemedicine and medication-assisted treatment. The company operates with a small team of experienced providers, counselors, and support staff, fostering a member-first culture.
Applies approved utilization criteria to monitor appropriateness of admissions and continued stay reviews.
Communicates with third-party payers for initial and concurrent clinical review to ensure medical necessity.
Tracks length of stay and resource utilization to identify at-risk patients and supports appeals on denied cases.
University of Utah Health is a patient-focused healthcare organization dedicated to enhancing health and well-being through patient care, research, and education. It is a nationally ranked Level 1 Trauma Center with five hospitals and eleven clinics, fostering a culture of collaboration, excellence, and respect.
Conduct comprehensive psychiatric intake evaluations and develop evidence-based treatment plans.
Collaborate with advanced practice providers and interdisciplinary teams to ensure coordinated care.
Prescribe medications through telehealth, including controlled substances, in accordance with regulations.
Legion Health is building AI infrastructure for autonomous medical care, starting with psychiatry. They are a startup with a culture of speed, ambition, and collaboration.
Own first-level reviews of pre-certification requests for medical appropriateness and necessity.
Drive post-service reviews and manage the appeals process for non-certified services.
Coordinate smooth discharges and redirect care in-network to keep patients on track.
Personify Health created the first personalized health platform, bringing health plan administration, wellbeing solutions, and care navigation together in one place. Their team serves employers, health plans, and health systems with a mission to empower people to lead healthier lives.
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.
Provide clinical leadership and medical oversight for audit programs involving governmental and commercial payer claims.
Evaluate medical necessity, level of care, coding accuracy, and documentation sufficiency using payer policies and clinical standards.
Support audit methodologies, clinical validation frameworks, and quality assurance to ensure regulatory alignment and defensibility.
Machinify is a leading healthcare intelligence company delivering value, transparency, and efficiency to health plan clients. Deployed by over 85 health plans representing more than 270 million lives, they bring an AI-powered platform alongside best-in-class expertise.
Serve as primary physician reviewer for Utilization Management (UM) cases, advising other reviewers and attending daily calls with health plan teams.
Establish 2-3 cases per day for up to 6 markets, ensuring attendance on health plan calls and weekly meetings.
Participate in Process and Quality improvement in delegated Utilization Management, utilizing excellent analytical and deductive reasoning skills.
ChenMed is a family-owned, physician-led primary care provider focused on improving healthcare for moderate-to-low-income seniors. The company is rapidly expanding, with a culture of innovation, kindness, and making a difference.
Serve as senior clinical leader ensuring high-quality, evidence-based substance use disorder treatment across a multi-state platform.
Partner with Clinical Services to strengthen clinical quality, safety, and governance through protocol development and audits.
Mentor clinical leaders and contribute to service line expansion and cross-functional partnership.
Boulder Care is a digital clinic for addiction medicine providing compassionate, evidence-based care. It is a growing company recognized as a Fortune Best Workplace in Healthcare.
Performs utilization review of cases to determine if the request meets medical necessity criteria in accordance with medical policies.
Collaborates with client personnel to resolve customer concerns and facilitates resolution of escalated cases.
Maintains written documentation per HealthHelp’s policy and ensures compliance with HIPAA, state, and federal regulations.
WNS, part of Capgemini, is an Agentic AI-powered leader in intelligent operations and transformation, serving more than 700 clients across 10 industries. With three global headquarters, operations in 13 countries, 65 delivery centers, and more than 66,000 employees, WNS combines scale, expertise, and execution to create meaningful, measurable impact.
Process state medical licenses for clinical professionals across multiple states.
Manage the full application lifecycle with medical boards, vendors, and clinicians.
Handle controlled substance, DEA, and malpractice insurance applications.
Curana Health is a national leader in value-based care for senior living communities, offering on-site primary care services and Medicare plans. Founded in 2021, it serves over 200,000 seniors across 1,500+ communities with more than 1,000 clinicians and was ranked #147 on the Inc. 5000.
Manage end-to-end payer enrollment for providers across commercial, Medicare, and Medicaid health plans.
Support provider licensing operations including new applications, renewals, and compliance activities.
Collaborate with internal teams and external partners to ensure timely credentialing and minimize patient care delays.
Oshi Health is a virtual digestive health practice transforming GI care by combining compassionate, multidisciplinary care with innovative technology. The company is a remote-first, mission-driven startup focused on revolutionizing how chronic digestive conditions are diagnosed and managed, with a culture emphasizing respect and inclusion.
Provide clinical guidance and support to a Virtual Nurse Practitioner in CA, ensuring high-quality patient care.
Ensure compliance with evidence-based clinical guidelines and protocols tailored to telemedicine.
Participate in case reviews, clinical audits, and quality improvement initiatives to maintain superior care standards.
Sprinter Health is an on-demand mobile health service that sends medical professionals to patients’ homes to perform blood draws, diagnostic and low acuity services, and wellness visits. We have a rapidly growing team of visionary leaders who are passionate about increasing access to care.
Serve as both a practicing clinician and clinical leader, managing Clinical Leads and driving clinical quality and performance.
Chair the Credentialing Committee, act as a collaborating/supervising physician for nurse practitioners, and participate in direct patient care with a 1-in-2 on-call schedule.
Collaborate across Operations, Product, Engineering, Legal, and Compliance to support safe and effective AI integration into clinical care.
Curai Health is an AI-enabled, fully virtual medical group making high-quality, asynchronous primary care accessible at scale. They are a mission-driven team of talented colleagues committed to living their values and driving meaningful impact in healthcare.
Assists with patient medication management and facilitates medication renewal requests.
Acts as a liaison between providers, patients, and pharmacies for prescriptions and prior authorizations.
Monitors prior authorization status and updates relevant parties throughout the process.
Mass General Brigham is a not-for-profit integrated health care system supporting patient care, research, teaching, and community service. They employ a diverse team of professionals including doctors, nurses, and tech experts, fostering a collaborative culture focused on exceptional care.
Lead clinical performance and drive quality outcomes across assigned ACOs, aligning with national strategy on value-based care initiatives.
Serve as a national clinical champion, influencing best practices and workflows for hypertension and risk management among partner practices.
Act as a thought partner to market leadership, contributing to growth and policy initiatives while representing the clinical voice in strategic workgroups.
Aledade is a public benefit corporation that empowers independent primary care practices to thrive in value-based care. Founded in 2014, we are the largest network of independent primary care in the country, with a collaborative, inclusive, and remote-first culture.
Provide clinical assessments, treatments, and medication management for substance use disorders via telehealth.
Conduct new patient evaluations and collaborate with physicians to deliver whole-person care.
Maintain accurate patient records and ensure excellent member experiences with a harm reduction philosophy.
Workit Health is an industry-leading telemedicine provider specializing in evidence-based addiction treatment. The team of dedicated professionals is passionate about reducing stigma and making recovery accessible to all.