Lead and oversee Prior Authorization Operations across all lines of business.
Manage Prior Authorization processes ensuring optimal efficiency and compliance.
Drive cross-functional collaboration to align with organizational goals.
Judi Health is an enterprise health technology company providing a comprehensive suite of solutions for employers and health plans. They are rebuilding trust in healthcare in the U.S. and deploying the infrastructure we need for the care we deserve.
Deliver comprehensive care navigation and access support for Sana members, ensuring they receive the right care at the right time, place, and cost.
Collaborate with cross-functional teams, including our virtual care practice and customer support, to provide seamless care navigation services.
Educate members on their care referral options, empowering them to make informed healthcare decisions.
Sana Benefits is building affordable health plans designed around Sana Care, their integrated care model connecting members with unlimited primary care and expert care navigation at no additional cost to them. They've compiled an innovative team with top talent from across the healthcare and technology industries to deliver engaging, modern, concierge-style healthcare for their members.
Serve as the vendor’s lead clinical subject matter expert on clinical denials management and prevention.
Partner with provider clients to design and implement best practices for denial prevention and appeal workflows.
Conduct complex clinical case reviews for DRG validation, identifying and defending clinically appropriate DRG assignments.
EnableComp offers specialty revenue cycle management solutions for healthcare organizations, leveraging industry expertise and its E360 RCM intelligent automation platform. EnableComp has received the Top Workplaces award multiple times and was recognized as Black Book's #1 Specialty Revenue Cycle Management Solution provider in 2024 and is among the top one percent of companies to make the Inc. 5000 list of the fastest-growing private companies in the United States for the last eleven years.
Conduct regular one-on-ones, performance reviews, and development planning.
Act as the primary escalation point for member issues and complex fertility-related financial and billing issues.
Use your continuous improvement mindset to define and iterate on processes, making positive enhancements to drive efficiency, value, and accountability toward KPIs.
Maven Clinic is the world's largest virtual clinic for women and families, aiming to make healthcare work for everyone. The company has over 2,000 employers and health plans trusting their platform, and they've won multiple awards for their culture and innovation.
Support development and communication of medical plans.
Lead the development and dissemination of scientific and medical data.
Build and maintain strong relationships with KOLs, researchers, and patient advocacy groups.
Jade Biosciences is focused on developing innovative therapies for autoimmune diseases. They are developing JADE101 to treat IgAN and have a second development candidate as well as an undisclosed antibody discovery program in preclinical development.
Oversee day-to-day operations of a Team of Analysts and/or Specialists, fostering a high-performing team.
Lead quality improvement initiatives by managing analytics to determine the greatest areas for quality and cost interventions.
Develop strategies to improve health plan performance, operational efficiency, and payer experience.
Aledade partners with independent practices, health centers, and clinics to build and lead Accountable Care Organizations (ACOs) anchored in primary care. They offer a comprehensive, value-based care solution that includes data analytics, guided workflows, and user-friendly technology, supported by on-the-ground experts.
Conduct thorough reviews of medical records for accurate coding compliance.
Identify opportunities for documentation improvement to enhance code accuracy.
Educate healthcare providers on proper coding practices and HEDIS measures.
Jobgether uses an AI-powered matching process to ensure applications are reviewed quickly, objectively, and fairly against the role's core requirements. Their system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company.
Lead planning and coordination of climate–health activities in close collaboration with PATH and AIIB.
Lead the design of an integrated climate–health EWS for extreme heat and air pollution in Brazil.
Support the development of a practical climate–health risk communication strategy for state and municipal health authorities.
PATH is a global nonprofit dedicated to achieving health equity. With more than 40 years of experience forging multisector partnerships and with expertise in science, economics, technology, advocacy, and dozens of other specialties, PATH develops and scales up innovative solutions to the world’s most pressing heath challenges.
Assists with medical record documentation requests and leverages medical management system to initiate case and/or authorization to support clinical processes.
Conducts fax and telephonic outreach; and written communications to members and/or providers to communicate status of UM/CM processes.
Actively participates in supporting department compliance and performance through administrative activities such as report monitoring/distribution, and other tasks as assigned by leadership.
Capital Blue Cross promises to go the extra mile for their team and community. Employees consistently vote it one of the “Best Places to Work in PA”.
Utilizes technical coding expertise to assign appropriate ICD-10-CM and CPT-4 codes to outpatient visit types
Reviews the medical record thoroughly, utilizing all available documentation to code appropriate diagnoses and procedures.
Collaborates with Orders Management Unit (OMU) and other coding divisions for NCD/LCD edit resolution.
Northwestern Medicine is committed to cultivating a patient-first approach within a positive workplace and is a leader in the healthcare industry. They offer competitive benefits and aim to care for their employees during their quest for better healthcare.