Conducts medical necessity reviews to determine appropriate patient class designation.
Performs timely reviews using InterQual Criteria and clinical nursing judgement.
Communicates with the provider team regarding patient class designation and medical necessity.
Emory Healthcare fuels professional journeys with benefits, resources, mentorship, and leadership programs. They offer a supportive environment for career growth.
Work directly with patients to deliver medication for opioid use disorder (MOUD) in a fully remote outpatient setting.
Independently initiate and manage buprenorphine treatment within a structured, team-supported model of care.
This is a 100% remote, full-time, W2 position.
Boulder Care is an award-winning digital clinic transforming addiction medicine. We provide fully virtual, evidence-based care delivered by a multidisciplinary team of clinicians and peer recovery professionals. Named by Fortune as one of the Best Workplaces in Healthcare, Boulder fosters a culture of kindness, respect, and meaningful work that delivers outstanding patient outcomes and moves the addiction medicine industry forward.
Triage patient care needs over the phone, providing medical advice, and coordinating with healthcare providers to address urgent concerns.
Use motivational interviewing and active listening skills to understand patient needs and effectively communicate to identify/resolve issues.
Implement strategies to prevent hospital re-admissions, including patient education, follow up telephonic touchpoints, and care coordination.
VitalCaring is a leading provider of home health and hospice services. Founded in 2021, it has over 65 locations across the country and is committed to fostering a culture of support, growth, and excellence for its team.
Licensed Nurse Practitioner in at least one Canadian province.
2+ years of Nurse Practitioner experience, demonstrated in menopause care.
Available minimum of 8 hours per week, check patient updates every 48 hours.
Felix is Canada's first end-to-end healthcare experience, providing online treatment, prescription delivery and ongoing care across a growing range of categories. They are a patient-driven, direct to consumer, digital healthcare company that puts patients in control of their health and wellbeing.
Provide real-time phone support for field nurses during patient visits.
Help troubleshoot common issues related to equipment, medication handling, documentation, and pharmacy protocols.
Support nurse adherence to therapy standards and pharmacy protocols.
Float is a full-stack platform for Specialty Pharma home infusion, aiming to make healthcare safer, easier, and more efficient. They connect nurses with patients for home medication visits and have facilitated over 82,000 patient visits, scaling their platform and operations.
Conduct thorough reviews of medical records to support program eligibility determinations.
Apply established clinical criteria and program-specific guidelines to evaluate medical necessity and eligibility determinations.
Accurately abstract and document relevant clinical findings, diagnoses, procedures, and treatment history from the medical record.
Daymark Health is a value-based oncology company redefining the cancer care experience for patients, providers, and health plans. Daymark’s comprehensive, personalized cancer care platform empowers patients with dedicated care navigation, symptom-focused support, behavioral health care, and social resources.
Use phone and video to provide follow-up care to post-hospital discharge patients.
Coordinate patient care between hospitals, pharmacies, and community providers.
Collaborate with the nursing team and meet individual performance targets.
Galileo is a team-based medical practice working to improve healthcare quality and affordability. They operate across 50 states, offering data-driven, multi-specialty care via phone and in-home visits; regional health plans, employers, and Fortune 500 organizations trust Galileo to improve population health.
Coordinate case management activities related to medication optimization, adherence, and therapeutic appropriateness
Collaborate with providers, PBMs, and pharmacy partners to support evidence-based medication use and access
Conduct member outreach, education, and follow-up to support adherence and understanding
Point C is a national third-party administrator (TPA) delivering customized self-funded benefit programs with local market presence. They focus on cost containment strategies with innovative solutions. They are driven by a clear and impactful mission.
Responsible for the coordination of services for members meeting established criteria, emphasizing education/self-management and promoting quality care and cost-effective outcomes.\n- Uses a collaborative process to assess Member needs, review options for services and resources, develop and implement a plan of care, coordinate resources, monitor progress, and evaluate Member status.\n- Addresses medical, psychosocial, clinical needs, and behavioral health needs including members with mental health and substance use disorder needs, providing counseling and referrals to community/local/state programs.
Capital Blue Cross is committed to providing excellent service to both its team and the community. Employees have consistently voted it as one of the “Best Places to Work in PA”, which indicates a positive and supportive company culture.
Implement the population health framework for assigned customers to improve overall health and utilization patterns.
Develop and maintain knowledge of current customer contracts and performance guarantees.
Serve as a liaison between all parties to the population health initiative assigned.
Capital Blue Cross promises to go the extra mile for our team and our community. They have been consistently voted one of the “Best Places to Work in PA.”