Perform medical record abstraction and chart review for assigned HEDIS measures.
Accurately enter abstraction results into MVP-designated systems.
Maintain required productivity and accuracy thresholds.
MVP Health Care is a not-for-profit health insurance company offering health plans across New York and Vermont. With over 40 years of experience, they have a people-centric culture and are recognized as a Best Place to Work.
You ensure prior authorization requests are completed in a manner that meets contractual requirements using evidence-based standards.
You participate in the Utilization Management (UM) Care Programs.
You evaluate medical records and health care data to interpret and apply policies and regulations.
Central California Alliance for Health is an award-winning regional Medi-Cal managed care plan that provides health insurance for children, adults, seniors and people with disabilities in Mariposa, Merced, San Benito and Santa Cruz counties. We are a group of over 500 dedicated employees, committed to our mission of providing accessible, quality health care that is guided by local innovation.
Provide evidence-based clinical care for pediatric patients, including acute issues and health education.
Champion NICU families through specialized education, care plans, and discharge support.
Collaborate with cross-functional teams to monitor adverse events and improve patient outcomes.
Pomelo Care is a virtual medical practice for women and children, providing care across pregnancy, postpartum, pediatrics, and menopause. It is a well-funded startup with a collaborative, data-driven team focused on improving outcomes for mothers and babies.
Conduct quality assurance audits of clinical review activities to ensure compliance with regulatory, accreditation, and client contract requirements.
Identify trends and root causes of issues to prevent client escalations and implement corrective actions.
Facilitate quality improvement projects and support cross-department collaboration on audit findings and process improvements.
WNS is an AI-powered leader in intelligent operations and transformation serving over 700 clients across industries like banking, healthcare, and insurance. With 66,000+ employees across 13 countries, the company focuses on human-led solutions and sustainable outcomes.
Manage a daily assigned review queue and identify clinically supported documentation opportunities in real time.
Communicate directly with physicians and APPs on documentation and quality risk adjustment gaps.
Contribute to reviewer calibration and quality assurance activities.
Tendo is a fast-growing, mission-driven company that creates software to improve the healthcare experience for patients, clinicians, and caregivers. It was recognized as one of Forbes' Top Startup Employers for 2024-2026.
Manage a pod of 5-7 Care Guide RNs while carrying a caseload of up to 40 active members.
Serve as the first clinical escalation point, monitoring quality metrics and driving corrections.
Requires an active RN license, 5+ years of clinical experience, and remote work from CA, WA, NV, OR, or ID.
Leap is a category-defining pioneer in employer specialty pharmacy, reshaping how life-changing therapies are delivered and financed for patients and employers. It is one of the fastest-growing benefits solutions and partners with Fortune 500 companies and leading TPAs.
Deliver patient motivational interviewing programs and share insights with leadership.
Provide specialist training on MS therapies and support patients and HCPs in-person or remotely.
Act as a Patient Concierge, building strong relationships and promoting treatment adherence.
Cycle Pharmaceuticals develops treatments for rare metabolic, immunological, and neurological conditions and oncology using advanced drug delivery technologies. The company is fast-growing with a collaborative, high-performing work culture.
Conduct comprehensive telephonic assessments and develop individualized care plans for patients with chronic conditions.
Use Motivational Interviewing to promote self-management and coordinate care with interdisciplinary teams.
Monitor biometric data and IVR trends to identify clinical risks and prevent hospitalizations.
The company provides telephonic nurse care management services for patients with chronic conditions, using technology-enabled care delivery. It has a mission-driven, collaborative culture focused on innovation and patient impact, with a fully remote team.
Serve as a clinical point of contact for referring providers and internal teams.
Coordinate and validate clinical documentation for authorizations.
Partner with Business Development Managers to support account planning and satisfaction.
IVX Health is a national provider of infusion and injection therapy for patients with complex chronic conditions. They are a growing company focused on collaboration, innovation, and employee development.
Coordinate patient journey processes and monitor key checkpoints within high-volume patient support programs.
Act as a patient advocate and navigator, addressing medication access and affordability challenges.
Analyze operational performance and recommend process improvements to accelerate patient access to therapies.
This company coordinates patient support programs to ensure timely access to essential medications. They offer a collaborative, remote-first culture that values patient advocacy, innovation, and professional growth.