Perform in-depth medical claim reviews using UB-04 and itemized statements.
Verify itemized charge accuracy based on policy and industry standards.
Validate system denials and suggest system enhancements for efficiency.
Machinify is a healthcare intelligence company that delivers value, transparency, and efficiency to health plan clients. They bring together an AI-powered platform, are deployed by over 85 health plans, and represent more than 270 million lives.
Conduct patient intake and follow up consultations to evaluate ketamine-assisted psychotherapy (KAP) eligibility, prescribe, and monitor patient outcomes via telemedicine
Suggest treatment plan changes based on patient response to medication and treatment outcomes
Engage in collaborative care with Journey Clinical member psychotherapists
Journey Clinical aims to transform mental health treatment by expanding access to Psychedelic-Assisted Psychotherapy. They have built a healthtech platform supporting licensed psychotherapists and in-house medical teams, and are backed by top-tier investors.
Coordinate and support the hospital’s Utilization Review and Case Management program.
Review patient charts and clinical documentation to verify medical necessity.
Monitor patient progress and coordinate care management strategies.
NeuroPsychiatric Hospitals is a national leader in behavioral healthcare, specializing in patients with acute psychiatric and complex medical needs. With hospitals in Indiana, Michigan, Texas, and Arizona, they’re expanding access to their unique model of care across the United States.
Acts as primary point of contact for oncology pain patients after referral to the CPC, until the patient has sufficient knowledge and resources to direct self-care.
Responsible for monitoring, coordinating care, and educating cancer patients and families as they move through the CPC.
Responds to criteria-based referrals as soon as possible, no longer than 24 hours, and schedules with appropriate provider within 72 hours.
OHSU is Oregon's only public academic health center that cares for patients, leads groundbreaking research, and trains the next generation of health care professionals. As Portland's largest employer, they offer opportunities to learn and advance in a system of hospitals and clinics across Oregon and Southwest Washington.
Conduct patient onboarding via phone, explaining program goals.
Receive follow-up calls and document information in charting systems.
Communicate concerns and changes in condition to the Provider Team.
CopilotIQ + Biofourmis is transforming in-home care with the industry's first AI-driven platform for pre-surgical optimization to chronic care. With commitment to enhancing the lives of seniors with chronic conditions and advanced data-driven insights, they're setting a new standard in accessible healthcare.
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, 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 provide high-technology health plans that expand benefits, increase access and transparency, and feature a personalized, human approach. Evry Health is the major medical division of Globe Life (NYSE:GL), which has 16.8 million policies in force, and more than 3,000 corporate employees and 15,000 agents.
Deliver coordinated, family-centered virtual Care Management by phone that improves behavioral health outcomes.
Develop personalized, goal-oriented care plans in collaboration with families and the multidisciplinary team.
Support members through behavioral health treatment plans, transitions of care, and episodes of acute behavioral health crises.
Included Health is a healthcare company that delivers integrated virtual care and navigation. They aim to raise the standard of healthcare for everyone by breaking down barriers to provide high-quality care for every person, offering care guidance, advocacy, and access to personalized virtual and in-person care.
Deliver coordinated, patient-centered virtual Care Management by telephone or video that improves members' health outcomes.
Help members navigate complex medical conditions, treatment pathways, benefits, and the healthcare system in general.
Assist throughout acute healthcare episodes, such as hospitalizations and rehabilitation stays, providing coordinated Case Management to support the member and their family.
Included Health is a healthcare company that delivers integrated virtual care and navigation, aiming to raise the standard of healthcare for everyone. They break down barriers to provide high-quality care for every person, offering care guidance, advocacy, and access to personalized virtual and in-person care.
Conduct comprehensive psychiatric evaluations via telehealth
Develop individualized treatment plans in collaboration with families
Prescribe and manage psychotropic medications; monitor effectiveness and adjust treatment
Backpack Healthcare believes clinicians deserve meaningful work that fits their lives. They are building a mental health system that honors both the provider and the patient, focusing on being sustainable, compassionate, and innovative, with a clinician-led culture.