Collaborates with members, family, and healthcare providers to coordinate services and address barriers.
Guides members to achieve optimal health by providing tools and information to understand their healthcare options.
Identifies and assesses members’ medical, behavioral, social, emotional, and financial needs.
Capital Blue Cross promises to go the extra mile for their team and community. They are one of the “Best Places to Work in PA”, with a caring and supportive culture that values professional and personal growth through training and continuing education.
Enhance the quality of member management and maximize satisfaction.
Assist in navigating the health care system as a collaborative health partner.
Promote wellness, problem-solve, and assist members in realization of their personal health-care related goals.
Guidehealth is a data-powered, performance-driven healthcare company dedicated to operational excellence. Driven by empathy and powered by AI and predictive analytics, Guidehealth leverages remotely-embedded Healthguides™ and a centralized Managed Service Organization to build stronger connections with patients and providers.
Contact patient and complete a thorough assessment, including physical, psychosocial, emotional, spiritual, environmental, and financial needs.
Develop treatment plan for standard and catastrophic cases in collaboration with the patient, caregivers or family, community resources and multi-disciplinary healthcare providers that include obtainable short- and long-term goals.
Advocate for the patient by facilitating the delivery of quality patient care, and by assisting in reducing overall costs; provide patient/family with emotional support and guidance.
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. They serve employers, health plans, and health systems with data-driven solutions that reduce costs while actually improving health outcomes and have a mission to empower people to lead healthier lives.
Responsible for the coordination of services for members meeting established criteria, emphasizing education/self-management and promoting quality care and cost-effective outcomes.\n- Uses a collaborative process to assess Member needs, review options for services and resources, develop and implement a plan of care, coordinate resources, monitor progress, and evaluate Member status.\n- Addresses medical, psychosocial, clinical needs, and behavioral health needs including members with mental health and substance use disorder needs, providing counseling and referrals to community/local/state programs.
Capital Blue Cross is committed to providing excellent service to both its team and the community. Employees have consistently voted it as one of the “Best Places to Work in PA”, which indicates a positive and supportive company culture.
Conduct targeted patient outreach to close care gaps and ensure timely care transitions.
Deliver high-touch engagement for high-risk patients to prevent readmissions through follow-up.
Collaborate with Practices to support interventions such as Transitional Care Management.
Aledade empowers independent primary care practices, helping them deliver better care and thrive in value-based care. Founded in 2014, they are the largest network of independent primary care in the country with a collaborative, inclusive, and remote-first culture.
Processes acute and post-acute inpatient medical and select intensive outpatient higher level of care requests through clinical review.
Interprets and applies InterQual criteria, CMS-issued guidelines, Capital Blue Cross Medical Policies to requests.
Collaborates with UM department staff and Medical Directors to make a final determination, and with Care Management staff on discharge planning.
Capital Blue Cross is an independent licensee of the Blue Cross Blue Shield Association. At Capital, employees work alongside a caring team of supportive colleagues and are encouraged to volunteer in their community.
Rapidly assess and prioritize patients' healthcare needs.
Conduct patient interviews, evaluate symptoms, and perform initial assessments.
Provide advice, educate, and coordinate care.
Virginia Mason Franciscan Health provides exceptional healthcare. They have a comprehensive network of 10 hospitals and nearly 300 care sites across the greater Puget Sound region.
Manage complex multi-workstream projects and oversee junior team members
Analyze data to implement performance improvement and organizational change
Collaborate with team members and clients to align with business objectives
Jobgether is a company that uses an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company.
Manage communications between patients and doctors and associated documentation.
Collaborate with Customer Service to troubleshoot patient requests pertaining to physician requirements.
Provide clinical feedback in response to patient inquiries involving medication, lab, side effects.
Hone is an online medical clinic transforming healthcare and enhancing longevity. They use scientific advancements to empower individuals to take control of their health. Hone is a remote-first employer with a focus on people and a culture that values collaboration and joy.
Handle inbound calls from patients and caregivers, providing compassionate and informed triage.
Assist with finding appropriate providers, community resources, and care solutions and coordinate priority virtual appointments.
Research information online and in Privia’s internal knowledge databases to make the most appropriate triage and care advice decisions.
Privia Health is a technology-driven, national physician enablement company that collaborates with medical groups, health plans, and health systems. They optimize physician practices, improve patient experiences, and reward doctors. Their platform is led by top industry talent and consists of scalable operations.
Engage with patients and healthcare providers via phone and virtually.
Serve as a clinical resource for therapy adherence, addressing inquiries related to medication and side effects.
Act as a liaison between healthcare professionals and patients, navigating therapy access challenges.
EVERSANA provides commercialization services to the life sciences industry with a global team of more than 7,000 employees. They serve over 650 clients, ranging from innovative biotech start-ups to established pharmaceutical companies, to bring therapies to market and support patients.
Provide clinical insight to support attorneys in healthcare legal cases.
Organize and manage electronic medical records for efficient case review.
Conduct medical literature research and prepare summaries for case allegations.
TLC Management's mission is grounded in compassionate care, accountability, and doing what’s right—every time. As a multi‑state senior care organization, they are committed to supporting our communities with strong clinical practices, ethical leadership, and thoughtful decision‑making.
Develop and analyze workflows for new client launches and existing program optimization.
Ensure business rules reflect customer’s needs and align with system functionality.
Communicate with customers and internal stakeholders.
CareTria helps clients with healthcare and pharmacy benefits. They value your passion and actions, seeking contributors to their team focused on client satisfaction.
Take inbound calls from patients, providers and members
Support members with their insurance needs, questions or concerns
Provide 24/7 Triage Support and assign priority for a Registered Nurse to provide health advice
Carenet Health pioneers advancements in healthcare consumer experience, interacting with 1 in 3 Americans daily. They integrate human touch with data-driven technology to improve healthcare, offering best-in-class clinical expertise and personalized solutions.
Provide non-promotional disease state education and therapy support to identified customers as directed by the client company.
Collect, confirm, and enter demographic data into the client's CRM system for program enrollment and documentation.
Maintain excellent quality and customer service while adhering to program guidelines and using only approved materials.
Inizio Engage is a strategic, commercial, and creative engagement partner that specializes in healthcare. They have over 7,000 experts working in more than 20 countries, forming a passionate, diverse team with global reach and local knowledge.
Lead registration and configuration of end users and partners on DrFirst products.
Enhance customer experience and satisfaction through client surveys.
Independently manage multiple priorities, including customer setups and registrations.
DrFirst empowers providers and patients to achieve better health through intelligent medication management. They improve healthcare workflows and help patients start and stay on therapy with end-to-end solutions, serving over 420,000 prescribers, 71,000 pharmacies, and 2,000 hospitals.
Analyze and improve UM business workflows, including clinical assessments, rules, and documents.
Validate Health Services programs against business requirements and acceptance criteria.
Partner with medical directors and cross‑functional teams to review, evolve, and update InterQual and custom clinical criteria.
Wellmark is a mutual insurance company owned by its policy holders across Iowa and South Dakota, and it has built its reputation on over 80 years of trust. They are motivated by the well-being of their members and committed to sustainability and innovation.
Build strong, consultative relationships with employer clients to become a trusted partner and advisor.
Manage enrollment marketing and campaign planning efforts to generate awareness of our programs.
Analyze, interpret, and present program engagement and outcome metrics to demonstrate value.
Big Health's mission is to help millions back to good mental health by providing fully digital, non-drug options for the most common mental health conditions. They've pioneered the first at-scale digital therapeutic business model in partnership with some of the most prominent global healthcare organizations.