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.
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.
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.
Guide patients through complex health concerns and help them achieve wellness goals while addressing social determinants of health.
Build trusting relationships through empathetic listening and create comprehensive care plans for consistent action.
Work 100% remotely as a 1099 contractor, setting your own hours and interacting with patients via video or phone.
Solace pairs patients with expert healthcare advocates to navigate the complex U.S. healthcare system and improve health outcomes. A lean, mission-driven Series C startup founded in 2022, its U.S.-based team is intense, urgent, and passionate about redefining healthcare.
Provide clinical and administrative support to a remote healthcare team during weekends, holidays, and peak patient volume.
Review laboratory results, coordinate referrals and pharmacy communications, and document actions in the EMR.
Work independently while collaborating with physicians, PAs, and care coordinators to ensure continuity of care.
The partner company is a growing virtual care organization delivering remote healthcare services across Canada. Their team focuses on inclusive, accessible patient care and multidisciplinary collaboration.
Perform prospective, concurrent, and retrospective utilization review to ensure medical necessity and appropriate level of care.
Research and respond to appeals, coordinate discharge planning, and analyze care patterns.
Collaborate with providers and internal teams to resolve benefit and eligibility issues.
HealthEdge provides AI-powered operational infrastructure for health insurance companies, helping them modernize operations and compete effectively. The company is expanding and investing in its people, offering opportunities to shape the future of healthcare technology.
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.
Conduct structured outreach to patients and caregivers throughout the treatment journey, providing program-approved education and support.
Identify barriers to treatment initiation and adherence, develop practical strategies, and escalate clinical or safety concerns as needed.
Accurately document interactions and outcomes while managing an assigned caseload and collaborating with case management teams.
We provide patient support programs that deliver individualized clinical education, treatment-support services, and care coordination to patients and caregivers. Our culture is supportive, dedicated, and teamwork-driven, and we are proud of our relentless focus on improving the lives of the patients we support.
Acts as a patient advocate coordinating transitions to the next level of care per regulations and agency policies.
Collaborates with MJHC and inpatient facilities to evaluate inpatients for transitional planning and home health services.
Uses telephonic outreach with discharge planners and case managers for Elderplan's SNP.
Elderplan and HomeFirst are Medicare and Medicaid managed care health plans under MJHS, offering personalized care to help people remain independent. MJHS fosters a collaborative culture focused on excellence, respect, work-life balance, and career development.
Provide empathetic, high-touch support to patients by answering non-clinical questions and guiding them through their care experience.
Support providers with administrative tasks in the Care Center, triaging and resolving patient messages accurately and efficiently.
Partner with clinical, pharmacy, insurance, and operations teams to navigate complex patient situations and deliver clear next steps.
Ro is a direct-to-patient healthcare company offering nationwide telehealth, labs, and pharmacy services to help patients achieve their health goals. Since 2017, Ro has served millions of patients across the US and is consistently recognized as a top workplace in healthcare, earning honors from Fortune, Great Place to Work, and PEOPLE.
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.
Provide education and self-management support based on the patient's unique learning style, and coordinate care as an advocate and resource.
Conduct comprehensive assessments of medical, behavioral, pharmaceutical, and social needs, and collaborate with the care team to design care plans.
Support population health initiatives and measure quality outcomes to reduce unnecessary utilization and improve patient health.
Aledade PBC empowers independent primary care by creating value-based contracts and flipping the script on fee-for-service. Founded in 2014, it is the largest network of independent primary care in the country, with a remote-first, collaborative, and inclusive culture.
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.
Provide timely, efficient, and accurate triage response and documentation according to nursing standards and physician protocols.
Evaluate patient needs, coordinate with clinical team members, and schedule patients for visits as needed.
Act as a clinical resource to non-clinical personnel and provide patient education on care, medications, and health promotion.
Piedmont Healthcare is a comprehensive healthcare system serving patients across Georgia. It operates as a large corporate organization supporting multiple ambulatory practices and contact center operations with a focus on patient-centered care.
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 nursing assessments and enroll patients in chronic care management programs.
Develop individualized care plans and coordinate transitions to improve outcomes.
Collaborate with providers and teams to support value-based care delivery.
Jobgether is an AI-powered job platform that matches candidates with hiring companies. It focuses on objective, efficient recruitment and partners with healthcare organizations.
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.
Provide high-quality, person-centered care management to high-risk members.
Coordinate care across medical, behavioral, and social services using evidence-based approaches.
Engage members through motivational interviewing and develop individualized care plans.
IEHP is a not-for-profit health plan serving members in Southern California's Inland Empire. It fosters a team culture focused on healing and inspiring the human spirit, offering competitive benefits and professional development.
Audit medical summaries, timelines and record classifications against source records.
Write clinical review guidelines and gold-standard examples for research and engineering teams.
Flag clinically significant omissions, causation issues and prior-history findings.
Brighterway builds AI-native claims software and administration for casualty claims, starting with workers' compensation medical-legal review. The team is small, technical, and close to customers, with everyone shipping and talking directly to users.
Provide patient-centered care navigation and telephonic clinical outreach to patients with chronic conditions.
Collaborate with PCPs, NPs, and care teams to coordinate treatment and support safe transitions home.
Serve as a key resource for patients, caregivers, and community agencies, implementing interventions that improve outcomes.
Vytalize Health is a healthcare company focused on value-based care for patients with chronic or serious conditions. It is a rapidly growing organization with an entrepreneurial, patient-forward culture, and you will play a key role in building a market leader.