Develop and implement comprehensive plans to drive patient throughput, efficient discharge planning, and readmission prevention.
Provide clinical direction for patient flow and ensure consistent application of systemwide standards and best practices for care coordination.
Leverage deep understanding of local regulations and resources, building relationships with state agencies and community partners.
CommonSpirit Health delivers more than 20 million patient encounters annually through more than 2,300 clinics, care sites and 137 hospital-based locations, in addition to its home-based services and virtual care offerings. CommonSpirit has more than 157,000 employees and contributes more than $4.2 billion annually in charity care.
Provide clinical leadership and subject-matter expertise to support the analysis, configuration, and administration of complex medical policy content within claims processing systems.
Ensure the accurate implementation of medical policies, review criteria, and authorization requirements, while maintaining the integrity of system infrastructure and serving as a key liaison between business and technical teams.
Research and analyze system and business issues, develop high-level requirements, test and implement solutions, and audit and document outcomes.
Wellmark is a mutual insurance company owned by policy holders across Iowa and South Dakota, built on over 80 years of trust and motivated by member well-being, not profits. They are committed to providing best-in-class service, sustainability, and innovation.
Ensure the development and implementation of action plans.
Lead regional/therapeutic area project resourcing.
Develop, mentor, manage and coach GCM Managers.
Precision for Medicine is a global precision medicine clinical research services organization. They improve the clinical research and development process for new therapeutics by integrating clinical operations excellence, laboratory expertise, and advanced data sciences.
Develop national disease area field medical strategy.
Provide leadership and direction of customer engagement tactics.
Develop organizational talent for future leadership positions.
Kardigan is a heart health company working to make cardiovascular disease preventable and curable. Led by Tassos Giannakakos and others, Kardigan's co-founders reunited after leading MyoKardia to discover and develop mavacamten, resulting in an acquisition by Bristol Myers Squibb in 2020.
Support medical policy functions by providing medical coding and system configuration.
Perform coding analysis and utilization reporting to recommend updates to medical policies.
Participate in cross-functional meetings to align with enterprise strategic priorities.
Wellmark is a mutual insurance company owned by policy holders across Iowa and South Dakota, built on over 80 years of trust. They are motivated by the well-being of their members and committed to sustainability and innovation.
Ensuring the accuracy, integrity, and quality of coding practices within the HIM department.
Conducting thorough reviews of clinical documentation, coding, and billing processes to ensure compliance.
Educating and training coding staff on best practices and updates in coding guidelines.
Cooper University Health Care is committed to providing extraordinary health care. They focus on clinical innovations and access to facilities, equipment, technologies and research protocols, and offer competitive rates, compensation programs, benefits, and career growth.
Responsible for planning and executing quality and oversight activities to ensure operational compliance.
Responsible for internal and external case audits for Capital and our delegated UM vendors.
Responsible for educating staff on findings, and the audit tool ensuring a consistent approach.
Capital Blue Cross promises to go the extra mile for our team and our community. This promise is at the heart of our culture, and it’s why our employees consistently vote us one of the “Best Places to Work in PA.”
Lead a team of professionals covering payer strategy and contracting.
Provide strategic input and commercial perspective to business development opportunities.
Deciphera is committed to equal employment opportunity and values diversity. They believe in providing a competitive compensation and benefits package to all employees.
Leading the Care Pathway (CP) Program for Neurology.
Serve as the voice of the healthcare provider and clinical teams as a trusted partner to build care pathways that close existing gaps.
Viz.ai is the leader in building and deploying AI-powered Care Pathways and helping doctors do their work. Their platform combines real-time, multimodal clinical data with deep clinician engagement to detect disease earlier, coordinate care teams, and help ensure patients receive the right treatment faster.
Responsible for establishing and maintaining positive relationships with various providers.
Drives provider engagement and communication, supporting network development.
Manages provider performance, shares data, and supports the implementation of quality initiatives.
CommonSpirit Health has over 700 care sites across the U.S., offering services from clinics and hospitals to home-based and virtual care. They are committed to building healthy communities and advocating for those who are poor and vulnerable.