Working with a team of Intake Coordinators and Utilization Review Nurses to ensure quality and timely determinations.
Striving for continuous improvement and an excellent work-life balance to produce top-notch results.
Coordinating and providing care management that is timely, effective, efficient, equitable, safe, and member centered.
Guidehealth is a data-powered, performance-driven healthcare company dedicated to operational excellence. Our goal is to make great healthcare affordable, improve the health of patients, and restore the fulfillment of practicing medicine for providers.
Performs final reconciliation on clinic/provider visits, resolving documentation issues.
Reviews, abstracts, and codes multiple services and complex cases, assigning classifications.
Researches/resolves high volume accounts/claims and educates staff on guidelines.
University of Utah Health is a patient-focused organization with a mission to enhance the health and well-being of people through patient care, research, and education. They have five hospitals and eleven clinics and are known as a Level 1 Trauma Center, nationally ranked for academic research and patient experience.
Conduct HCP needs assessment nationally and contribute to identifying educational gaps.
Lead the planning and development of a strategic health education plan.
Lead the design of forward-thinking health education strategies and tactics.
AbbVie discovers and delivers innovative medicines and solutions that solve serious health issues today and address the medical challenges of tomorrow. AbbVie strives to have a remarkable impact on people's lives across several key therapeutic areas. AbbVie Canada is one of the Best Workplaces in Canada.
Accurately assign ICD-10-CM, CPT, and HCPCS codes for Behavioral Health and SUD services.
Review clinical documentation to ensure coding accuracy and compliance.
Stay current with coding updates, payer policies, and regulatory changes.
Steadfast Health is dedicated to setting a new standard of care for substance use disorder (SUD) treatment. They are rapidly growing and building a dedicated team of professionals, focused on low-barrier, high-quality care accessible to all.
Responsible for the review and update of existing concepts based upon required periodic review cycle or as needed based upon client or regulatory changes.
Collaborates with and leverages Segment Specialist expertise to ensure on-point results and ensure training material updates as necessary.
Conduct research, identify impact on existing concepts, and document accordingly and support activities required to package concepts.
Machinify is a healthcare intelligence company that delivers value, transparency, and efficiency to health plans. They are deployed by over 75 health plans, representing more than 170 million lives, and use an AI operating system, combined with expertise, to untangle healthcare data.
Oversee Housing Services programs, ensuring operational excellence and quality of care.
Provide leadership, coaching, and supervision to the Housing Navigator team.
Drive process improvements and support member/partner escalations for housing stability.
Zócalo Health is a tech-driven healthcare provider built specifically for Latinos, by Latinos, developing a new approach to care designed around shared and lived experiences. Founded in 2021, it aims to improve the lives of communities with culturally competent care, backed by healthcare and social impact investors.
Complete timely review of healthcare services using appropriate medical criteria to support determinations.
Document clinical findings and rationale clearly and accurately in accordance with federal/state regulations, URAC standards, and Guidehealth policies.
Communicate precertification and concurrent review decisions—verbally and in writing—to required parties within defined timeframes.
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.
Build Maven’s ability to drive sales through payer channels through strategic and analytic support to identify potential clients for all Maven programs and build a business case for them.
Lead end‑to‑end outcome evaluations for payer clients, designing robust methodologies and performing hands‑on analyses of medical and pharmacy claims, eligibility files and Maven platform data.
Own technical and clinical relationships with payer stakeholders, serving as their primary point of contact for study design, data sharing, results interpretation and ongoing analytic support.
Maven is the world's largest virtual clinic for women and families on a mission to make healthcare work for all. More than 2,000 employers and health plans trust Maven's end-to-end platform to improve clinical outcomes, reduce healthcare costs, and provide equity in benefits programs.
Oversee a comprehensive national clinical governance framework, including PC compliance, quality oversight, risk identification/mitigation.
Develop and operationalize an organization-wide patient safety program, including incident review processes, root-cause analyses, and system-level action plans.
Build and oversee a comprehensive clinical education program, including onboarding, continuing education, and targeted training in designated specific skills.
Headway’s mission is to build a new mental health care system everyone can access. They have built technology that helps people find great therapists with the first software-enabled national network of providers accepting insurance. Headway has over 60,000 mental healthcare providers across all 50 states who run their practice on their software and have served over 1 million patients.
Accurately codes inpatient conditions and procedures using ICD guidelines.
Reviews medical record documentation and assigns ICD CM and PCS codes.
Collaborates with Clinical Documentation Improvement Specialists to address documentation concerns.
Marshfield Clinic Health System is dedicated to enriching lives through accessible and compassionate healthcare. They prioritize the needs of patients and customers and value innovation and teamwork.