Evaluates member health metrics and professional resources to inform UM/CM initiatives and programs.
Refers members and providers to G.E.H.A resources and programs, as indicated, maximizing their health plan benefits.
Monitors and evaluates program effectiveness, tracks relevant metrics, and reports outcomes.
Government Employees Health Association (G.E.H.A) is a nonprofit member association providing health and dental benefits to millions of federal employees and retirees since 1937. G.E.H.A is headquartered in Lee's Summit, Missouri, offering hybrid and work-from-home options for many roles.
Communicate and provide education to members and providers on insurance plan benefits and digital health solutions.
Employ active listening & motivational interviewing skills, and can handle difficult calls tactfully, courteously, professionally and document accordingly that can build patient trust and engagement.
Accurately track and document work on a variety of internal software tools and platforms.
Evry Health is on a mission to bring humanity to health insurance. They are a high-technology health plan that expands benefits, increases access and transparency, and features a personalized, human approach. Evry Health is the major medical division of Globe Life (NYSE:GL) with more than 3,000 corporate employees and 15,000 agents.
Provide psychiatric care to perinatal, perimenopausal, and menopausal patients via telehealth.
Practice within a care model that prioritizes clinical quality and collaboration with therapists.
Adapt and grow with an early-stage startup environment, contributing to evolving workflows and practices.
Seven Starling is a leading virtual provider of women's behavioral health services, supporting women through reproductive life stages. They combine therapy, peer support, and medication management to treat mental health conditions and partner with healthcare providers and health plans to make care accessible and affordable.
Provide health assessments and treatment solutions via telephone, video, or chat functions.
Receive inbound phone calls from patients seeking answers to various medical conditions.
Stay up to date with current health trends and recommendations.
PWNHealth is a national clinician network improving early disease detection and prevention using advanced diagnostics and telehealth, serving all 50 states and Puerto Rico. They are a mission-driven company with a positive culture, backed by leading growth equity firms Spectrum Equity and the Blue Venture Fund (BVF).
Review medically complex claims, pre-authorization requests, appeals, and fraud/abuse referrals.
Assess payment determinations using clinical information and established guidelines.
Evaluate medical necessity, appropriateness, and reasonableness for coverage and reimbursement.
Broadway Ventures delivers tailored solutions that drive operational success, sustainability, and growth for government and private sector clients. As an 8(a), HUBZone, and Service-Disabled Veteran-Owned Small Business (SDVOSB), they empower clients with expert program management, cutting-edge technology, and innovative consulting solutions.
Nurse conducts clinical review of cases not meeting criteria by performing clinical intake.
Adjudicates (closes), requests additional clinical information or escalates to Medical Directors.
Active PRC and USRN License required with 2 years Bedside Experience.
WNS, part of Capgemini, is an Agentic AI-powered leader in intelligent operations and transformation, serving more than 700 clients across 10 industries. With 66,000 employees, WNS combines scale, expertise and execution to create meaningful, measurable impact.
Conduct new patient visits via telemedicine, focusing on chronic condition management.\n- Collaborate with RNs to develop individualized care plans tailored to patients' needs.\n- Perform telemedicine visits for ailments experienced by residents in senior living communities.
Red Cell Partners is an incubation firm building and investing in rapidly scalable technology-led companies that are bringing revolutionary advancements to market in healthcare, cyber, and national security. United by a shared sense of duty and deep belief in the power of innovation, Red Cell is developing powerful tools and solutions to address our Nation’s most pressing problems.
Provide empathetic, non-judgmental care while maintaining clear emotional boundaries
Accurately document consult outcomes to support safe and effective prescribing
Montu is Australia's largest healthtech business with a focus on alternative healthcare. Founded in 2019, it supports patients, doctors and pharmacies through its Alternaleaf clinic, offers accredited healthcare education to clinicians via its SAGED platform and dispensing solutions to pharmacies across Australia through Leafio.
Provide empathetic, non-judgmental care while maintaining clear emotional boundaries
Accurately document consult outcomes to support safe and effective prescribing
Montu is Australia's largest healthtech business focusing on alternative healthcare. Founded in 2019, it supports patients, doctors, and pharmacies, and is known for its rapid growth and being named #1 on LinkedIn’s Top Startups Australia 2024.
Coordinate with Front Desk Coordinators to manage house call requests and assist with patient care in the clinic.
Formulate a differential diagnosis and treatment plan for urgent and emergent care in non-clinic settings.
Document clinical evaluations and treatments accurately in the electronic health record (AthenaHealth).
Sollis Health is a medical membership that’s on-demand 24/7, 365. They provide concierge care and follow-up with ER-trained medical teams, on-site labs and imaging, expedited specialist appointments, and care navigation. With locations in multiple states.