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.
Conduct high-volume telehealth intake appointments to assess patient goals and explain service offerings.
Manage scheduling, lab orders, prescription logistics, and EHR maintenance for a fully remote care team.
Drive patient engagement through strategic outreach, coaching, and issue resolution to ensure high satisfaction.
Bold is the leading healthy aging platform, offering personalized, evidence-based exercise programs for Medicare members that help prevent falls, reduce pain, and increase activity. The company is backed by leading investors including Andreessen Horowitz and Khosla Ventures and has a patient-centered care team.
Partner with Clinical, Claims, and Payment Integrity peers to review claims for DRG related issues on a prospective and retrospective basis that drive inaccurate payments to providers.
Proactively identify overpayments to ensure accurate claims payments on inpatient services.
Participate in collaborative discussions with MDs to verify the clinical rationale behind billed procedures.
Clover Health is reinventing health insurance by combining the power of data with human empathy to keep its members healthier. They have created custom software and analytics to empower their clinical staff to intervene and provide personalized care to the people who need it most.
Supervise day-to-day operations of assigned Utilization Management staff.
Provide full people management for assigned Utilization Management teams, including hiring and performance management.
Drive team performance against key metrics, including engagement, productivity, and quality scores.
Personify Health has created a personalized health platform, bringing health plan administration, wellbeing solutions, and care navigation together. Their data-driven solutions aim to reduce costs while improving health outcomes, empowering people to lead healthier lives.
Own the development and maintenance of clinical and reimbursement policies, ensuring perfect alignment with CMS regulations.
Design and oversee a robust audit program that monitors adjudication system output against clinical policies, pricing, benefit rules, and provider contract terms.
Lead the implementation of AI initiatives to automate the monitoring of reimbursement policies and contract validation.
Clover Health aims to improve the health of its members by leveraging technology and data-driven insights to provide personalized, high-quality care. They are a mission-driven team of individuals, who are passionate about solving healthcare's most complicated problems, and strive to put members first.
Perform retrospective medical chart reviews to pinpoint areas for improvement.
Interpret performance data to uncover learning opportunities.
Lead diagnosis documentation education for clinical audiences.
Aledade empowers independent primary care practices. Founded in 2014, they are the largest network of independent primary care in the country, focusing on value-based care and a collaborative, inclusive, remote-first culture.
Negotiate MA & Medicaid value-based care contracts with prospective payer partners.
Collaborate with Senior Leadership to qualify and source market growth and expansion for multi-year risk arrangements.
Build and manage relationships with payers and other key stakeholders to resolve issues and optimize performance.
Aledade empowers independent primary care practices to deliver better care to their patients and thrive in value-based care. Founded in 2014, they are the largest network of independent primary care in the country, operating with a collaborative, inclusive, and remote-first culture.
Oversee the Commercial segment within the Strategic Payer Partnerships team ensuring performance goals and objectives are met.
Collaborate with Executive Leadership to shape Aledade's strategy for value-based contracting on behalf of independent primary care practices.
Lead, direct, and evaluate a team of senior leaders ranging from Manager to Sr. Director.
Aledade empowers independent primary care practices to deliver better care to their patients and thrive in value-based care. Founded in 2014, they are the largest network of independent primary care in the country with a collaborative, inclusive, and remote-first culture.
Collaborate with stakeholders to design trainings and resources for performance improvement.
Coordinate across field teams for streamlined delivery of resources, including direct consulting.
Operationalize Collaborative Learning Networks by leveraging data insights and standard curriculums.
Aledade empowers independent primary care practices to deliver better care to their patients and thrive in value-based care. Founded in 2014, they are the largest network of independent primary care in the country with a collaborative, inclusive and remote-first culture.
Manage Health Services staff, promoting a healthy work and learning environment while ensuring adequate training and coverage.
Direct quality improvement projects, model a caring philosophy, and champion age-appropriate developmental considerations.
Collaborate with leadership to monitor expenses, ensure budget compliance, and support the integrated model of care.
Imagine Pediatrics is a tech-enabled, pediatrician-led medical group reimagining care for children with special health care needs. The company offers competitive benefits and fosters a culture guided by core values like Children First and Earn Trust.