As a Health Plan Implementation Manager at BetterHelp, you’ll serve as the primary liaison between the organization and contracted health plans, ensuring compliance with contract terms, delivering on performance metrics, and driving collaborative outcomes. This is a critical role for maintaining strong health plan relationships and supporting the growth and sustainability of behavioral health services.
Our Care Delivery team consists of care coaches and care advocates who help our members navigate digital care and access the tools to unlock their best experience and outcomes. As a Care Coach, you’ll coordinate care for our members beyond the digital space through goal setting and program opt-in, you’ll drive behavior change and improved outcomes for higher risk members.
Be part of a world-class academic healthcare system as a Registrar in Trauma, responsible for the collection and reporting of data regarding trauma identification, treatment, and follow-up on each eligible trauma patient. The Trauma Registrar will participate in data quality activities such as peer audits and maintain the trauma registry database(s).
Identify, create, and implement home health clinical practice standards for in-home care management that deliver high value clinical and financial outcomes. Establish in-home clinical assessment and practice standards that align with in-home procedures and policies. Establish protocols and standards for the in-home disciplinary care team to improve patient experience. Prepare and conduct clinical case reviews for mitigation of hospitalization use.
This position processes medical record requests efficiently, ensuring accuracy and top-quality customer service. The role requires safeguarding patient privacy, ensuring authorized access to medical information, and compliance with requests, company policy, and HIPAA regulations. This intermediate-level position requires at least 1 year of related HIM experience.
The Utilization Management Clinical Specialist will play an important role in SmarterDx’s next product launch in the Utilization Management and Case Management space. This role will work closely with Product and Data Science to design and refine strategies that help hospitals optimize resource use, ensure appropriate levels of care, and support timely and effective patient management. The specialist will bring a clinical and operational view to patient status determination, documentation workflows, and utilization review, contributing to AI tools that support care coordination and medical necessity compliance.
Responsible for reviewing OASIS and/or coding for home health and hospice agencies, you’ll play a critical role in ensuring the integrity of clinical documentation and reimbursement. You’ll review OASIS assessments, validate ICD-10 coding, and provide actionable insights that support quality care and operational excellence. If you're detail-oriented, certified, and thrive in a remote, fast-paced environment, we’d love to have you on our team.
This role provides cross- market clinical leadership and oversight, ensuring excellence in care delivery across Nest Health's growing footprint by supporting and supervising Advanced Practice Provider (APP) Pod Leaders and contracted physicians. A key leader in Nest's clinical leadership team reporting to the Chief Clinical Officer. The role drives performance in quality, patient experience, clinical outcomes, and value-based care.
Manage a team of nurses, medical coders and analysts that create and maintain policies in the Cotiviti payment policy library. Work collaboratively with the global and onshore Medicaid teams as well as other payment policy teams. A hands-on position working diligently with team members to meet goals and deadlines; interpret guidelines, perform audits, and analyze claims data. Mentor team members to enhance their knowledge and growth.
Assist the Medical Review team by providing education and identifying training opportunities during mentoring process and participate in on-site audits and ALJ hearings as needed. Analyze, evaluate, and conduct medical review investigations, studies, and data review in accordance with the UPIC policies and contract responsibilities. Conduct in depth claim review of providers suspected of fraud.