Provide clinical review and correspondence for utilization management, including medical necessity reviews and member communications.
Collaborate with Medical Directors to ensure evidence-based decisions that meet NCQA and CMS standards.
Maintain productivity and quality while working 100% remotely in a fast-paced environment.
Cohere Health’s clinical intelligence platform and agentic AI-powered solutions connect health plans’ strategic goals and providers’ needs, optimizing the speed, cost, and quality of care. With over 250 employees, the company fosters a supportive, growth-oriented environment and has been named to the Inc. 5000 list and a Top 5 LinkedIn Startup.
Provide patient information and education to ensure safe, effective, and appropriate use of Provenge from enrollment to completed infusions.
Collaborate with Patient Services, Sales Teams, and Medical Affairs to support patients and healthcare professionals.
Document all communications and conduct activities within legal and compliance guidelines, with potential field travel.
Dendreon is a biotechnology company focused on developing immunotherapy treatments for cancer, harnessing the power of the immune system to attack cancer cells. Headquartered in Seal Beach, California, with locations in Georgia and nationwide teams, they foster a purpose-driven, value-based culture putting patients first.
Review payer/provider contracts to identify key reimbursement provisions.
Validate and correct reimbursement terms within the Turquoise platform.
Self-QA work to ensure accuracy of loaded rates and share product feedback.
Turquoise Health is a Series C price transparency platform for finance leaders across healthcare. Backed by top venture firms, we power price transparency for over 300 enterprises and are building a more open, efficient healthcare marketplace with a remote-first US-based team.
Review assigned TEFCA directory entries against authoritative corroboration sources and apply the approved review methodology.
Research, validate, and reconcile healthcare directory data across multiple reference sources, documenting findings in Jira.
Classify entries using a four-tier disposition taxonomy and escalate exception-path entries to the Lead Analyst.
Broadway Ventures is an 8(a), HUBZone, and Service-Disabled Veteran-Owned Small Business (SDVOSB) that provides expert program management, technology, and consulting solutions to government and private sector clients. As a small business, they emphasize integrity, collaboration, and excellence in their tailored solutions.
Support payer audits and medical record reviews, ensuring timely submission of documentation.
Manage medical review requests and appeals associated with CMS contractors and regulatory agencies.
Review clinical documentation using audit checklists and partner with teams to gather required records.
VitalCaring is a provider of home health and hospice services founded in 2021. They are a growing company focused on quality and compliance, with a mission to deliver exceptional patient care.
Review and analyze insurance denials using EOBs, payer correspondence, and claims data to determine appropriate resolution strategies.
Differentiate between clinical and technical denials and identify required next steps for appeals or reprocessing.
Prepare and submit appeals using supporting documentation such as medical records, appeal letters, and clinical justification when necessary.
Jobgether is an AI-powered job matching platform that connects candidates with hiring companies. They use automated technology to review applications and share top-fitting candidates directly with employers, ensuring a fair and efficient hiring process.
Deliver personalized nutrition guidance and lifestyle coaching via three-way chat with members and AI assistant.
Monitor care plans and health data, intervening when members need clinical input to stay on track.
Provide accountability and encouragement, sharing member feedback to improve the product experience.
Sword Health is building AI to heal billions, pioneering an AI-native care approach that removes traditional healthcare barriers. Since 2020, it has expanded across multiple health areas, with over 700,000 members and 1,000+ enterprise clients, backed by $500 million from top investors.