Process incoming requests for first, second level, and external appeals to ensure high customer service and productivity.
Review cases to verify appeal qualifications, update case types, and submit information to independent review organizations.
Communicate effectively with appeal pharmacists and make outreach attempts to obtain necessary information for case reviews.
Judi Health is an enterprise health technology company providing a comprehensive suite of solutions, including pharmacy benefit management and health benefit management, for employers and health plans. The company is a Certified B Corp that values a diverse workplace and is rebuilding trust in U.S. healthcare through scalable, secure platforms.
Assess, plan, and coordinate comprehensive health needs for individuals and families to promote quality, cost-effective outcomes.
Act as a liaison with members, families, employers, providers, and insurance companies, implementing case management for catastrophic and chronic cases across the care continuum.
Interact telephonically or in-person, potentially visiting homes or worksites, to evaluate medical status and develop proactive care plans for optimal wellness and return to function.
CVS Health aims to build a more connected and compassionate health experience around every individual. It is a large healthcare company with a culture where employees are described as passionate, accountable, and safety-focused.
Conduct comprehensive Functional Behavior Assessments using telehealth, video-capture technology, caregiver interviews, and standardized tools.
Develop individualized, data-driven treatment plans and ensure reports meet payer and internal quality standards.
Serve as a clinical gatekeeper, collaborating with intake and leadership to ensure efficient onboarding and contribute to scalable system improvements.
FronteraCare delivers life-changing autism services to children and families across New Mexico and Colorado, providing diagnostic evaluations and ABA therapy. They are a mission-driven team in a fast-paced, evolving startup culture, focused on expanding access to exceptional developmental healthcare.
Assess nutritional needs, analyze growth trends, and develop personalized nutrition care plans for pediatric patients with chronic conditions.
Provide age-appropriate education and counseling to patients and caregivers on disease-specific diets, formulas, and feeding regimens.
Document care plans and collaborate with multidisciplinary internal and external care teams to integrate nutrition principles and improve patient outcomes.
Imagine Pediatrics is a pediatrician-led medical group that uses technology to provide virtual-first and in-home medical, behavioral, and social care for children with special health care needs. The company is a growing startup with a culture centered around core values like putting children first, earning trust, and embracing humanity.
Conduct thorough evaluations of patients' physical, cognitive, and emotional functioning to determine their needs and goals.
Develop individualized treatment plans and provide remote occupational therapy services, including exercises and interventions to improve functional abilities.
Educate patients and caregivers, maintain accurate documentation, and adhere to ethical, legal, and technological standards for telehealth delivery.
All Care Therapies is a leading provider of Physical, Occupational, Speech, and ABA therapy services, delivering care through virtual, in-home, and clinic-based settings across California, Texas, and Nevada. We are a therapist-owned and operated organization with a collaborative, patient-centered culture, combining innovative technology with dedicated clinicians to provide flexible, high-quality care.