Review and process appeals submitted by members and providers, ensuring timely and accurate resolution.
Evaluate cases, determine next steps, and manage multiple priorities while meeting strict turnaround times.
Review clinical and medical records, summarize findings for Medical Director review, and operate within turnaround times as short as 24–72 hours.
BlueCross BlueShield of Tennessee has been helping Tennesseans find their own unique paths to good health since 1945. At BCBST, they empower their employees to thrive both independently and collaboratively, creating a collective impact on the lives of their members.
Performs activities related to insurance company notifications and obtaining certifications/authorizations related to Utilization Review.
Communicates clinical information and updates to insurance companies as requested or required to justify medical necessity.
Liaises with third-party payers regarding UR requirements and assists with complex authorization needs impacting patient transition planning.
Phoebe Putney Health System is southwest Georgia’s preferred career choice for professionals who want to improve the community’s health by joining a respected, cutting-edge team. They are one of the area’s premier employers, offering a close-knit culture, outstanding benefits and many ways to develop your career.
Coordinate care and collaborate with multiple disciplinary team members to improve the quality of care and clinical outcomes.
Conduct thorough assessments to determine unmet needs and develop individualized care plans.
Promote quality cost-effective outcomes with the goal of improved care coordination.
Dignity Health Medical Foundation works hand-in-hand with physicians and providers throughout California to provide comprehensive health care services. They strive to create purposeful work settings where staff can provide great care, while advancing in knowledge and experience through challenging work assignments and stimulating relationships.
Conduct initial and follow-up telehealth assessments, initiating/adjusting plans of care, and coordinating with providers via a secure platform.
Interpret insights from the Circadia platform to prioritize high-risk patients, driving timely interventions to prevent decline and unnecessary ED visits.
Complete documentation/charts within the same day, efficiently completing 25+ tele visits per day for home health patients in the SoCal/OC area.
Circadia Health is a healthcare AI company focused on preventing avoidable hospitalizations and transforming senior-care operations. They have a platform that combines contactless sensing with predictive models and enterprise integrations, touching 40,000+ post-acute patients daily.
Responsible for conducting monthly clinical check-ins, identifying and addressing clinical concerns.
Reinforcing care plans, escalating issues appropriately, and ensuring clinical documentation accuracy.
Supporting patients between office visits while collaborating closely with Evergreen’s providers, care teams, and leadership.
Evergreen Nephrology partners with nephrologists to transform kidney care through a value-based, person-centered, holistic, and comprehensive approach to kidney care. They are committed to improving patient outcomes and improving quality of life.
Conduct responsible and compassionate psychiatric assessments, diagnoses, treatment planning, medication management, and referrals.
Prescribe, titrate, refill, and monitor psychotropic medications across major medication classes.
Partner closely with therapists, MDs, NPs, PAs, acupuncturists, mental health leads, and clinical leaders to support coordinated, patient-centered care.
Tia is building a new model for women’s healthcare by integrating primary care, mental health, gynecology, and wellness across in-person and virtual settings. They are a Series D, venture-backed company, and they focus on creating a culture of excellence in people, process, and product.
Pulling, sorting, and analyzing data to determine member eligibility for the Population Health management Program.
Coordinating and providing care that is timely, effective, equitable, safe, and member-centric while following HMO processes.
Managing case assignments which includes outreach, documentation, monitoring for case progression, and case closure.
Guidehealth is a data-powered healthcare company dedicated to operational excellence. They aim to make healthcare affordable, improve patient health, and restore fulfillment in practicing medicine. Guidehealth is a growing and innovative organization and employees are expected to adapt to evolving business needs.
Conducting virtual assessments, diagnoses, and evidence-based treatment for patients.
Managing and coordinating care for chronic conditions.
Providing preventive care, wellness counseling, and health education.
Curai Health aims to transform healthcare using AI and clinical expertise to make care more affordable and accessible. They are a mission-driven team committed to collaboration and driving meaningful impact in healthcare.
Conduct psychiatric evaluations and provide evidence-based treatment to adult and older adult population with mental health disorders.
Develop treatment plans tailored to each patient’s individual needs.
Complete timely, accurate documentation and coding
Salma Health is building a new model for brain healthcare that combines advanced diagnostics, rapid interventions, and continuous monitoring with compassionate care and streamlined operations. They offer accelerated treatments, leading to effective, rapid relief, and are powered by AI-driven insights and personalized care plans.
Conduct virtual consultations using telehealth platforms.
Develop personalized care plans focusing on hormonal balance.
Educate patients on treatment options and lifestyle modifications.
Ways2Well is redefining the future of healthcare. As a leader in regenerative and preventive medicine, they empower patients to take control of their health through data-driven, personalized care. They offer competitive compensation, strong benefits, and real room to grow, lead, and make your mark.