Review Home Health prior authorization requests using CMS guidelines and clinical judgment.
Lead and mentor the Home Health UM nursing team, ensuring quality and compliance.
Collaborate with cross-functional partners to optimize care and improve utilization.
Clover Health provides high-quality, affordable healthcare for America's seniors by combining data, technology, and preventive care. They are a mission-driven team with diverse expertise, focused on improving members' lives through innovation and empathy.
Review patient information and conduct video consultations during online visits
Prescribe based on predetermined treatment regimens using comprehensive templates
Work 100% remotely with no in-person patient interaction required
Florida Telehealth Medical Group is an innovative telemedicine company currently operating in 49 states and growing rapidly. We treat tens of thousands of patients every month through our seamless video chat platform.
Provide direct clinical support to patients undergoing medication abortion via telemedicine.
Deliver timely triage, clinical assessment, and patient-specific nursing guidance.
Ensure culturally responsive, evidence-based care in a fast-paced, mission-driven startup environment.
Hey Jane provides safe, discreet medication abortion and reproductive health care via telemedicine. The in-house clinical team, composed of board-certified doctors, advanced practice clinicians, nurses, and patient care advocates, has helped over 100,000 patients, and the company is committed to equitable, judgment-free care.
Conduct age-appropriate history and virtual exams for patients of all ages.
Evaluate, diagnose, and treat a broad range of acute, chronic, and mental health conditions.
Develop and document treatment plans, counsel patients, and maintain knowledge of clinical best practices.
Included Health is a healthcare company delivering integrated virtual care and navigation. It is an equal opportunity employer committed to raising the standard of healthcare for everyone.
Review and evaluate electronic medical records of emergency department admissions to screen for medical necessity using InterQual or MCG criteria.
Apply evidence-based clinical guidelines to assess and ensure proper utilization of healthcare resources.
Enter clinical review information into the system for transmission to insurance companies for authorization.
Netsmart provides advanced healthcare technology solutions for post-acute and human services clients, enabling better care through a comprehensive platform. We are a vision-driven team passionate about innovation, and we have been recognized as one of the best companies to work for.
Provide after-hours triage, clinical assessment, and interventions via phone to support patients and families.
Coordinate care with physicians, facilities, and internal teams while dispatching visits and managing vendor services.
Document all interactions accurately in the EMR and review team documentation for compliance.
Moments Hospice is a hospice care provider dedicated to delivering compassionate, patient-centered end-of-life support. The organization fosters a structured, supportive culture with experienced leadership and opportunities for internal growth.
Ensures prior authorization requests meet contractual requirements and are reviewed using evidence-based standards.
Performs concurrent or retrospective review of acute in-patient care services using established criteria.
Participates in Utilization Management Care Programs.
Central California Alliance for Health is a regional non-profit health plan providing accessible, quality health care guided by local innovation to members in five California counties. The organization employs over 500 dedicated employees in a respectful, diverse, professional, and fun culture.
Provide direct clinical support to patients undergoing medication abortion through telemedicine.
Respond to medical questions, deliver triage, clinical assessment, and nursing guidance.
Ensure patients feel heard, supported, and cared for with trauma-informed, culturally responsive care.
Hey Jane provides safe, discreet medication abortion treatment and reproductive health services via telemedicine. They have helped over 100,000 people, with a clinical care team of board certified doctors, advanced practice clinicians, nurses, and patient care advocates.
Conduct Skilled Nursing Facility medical claims audit reviews applying medical review guidelines.
Document findings and generate articulation letters for audit results.
Collaborate with audit team and clients to improve medical policies and workflows.
Machinify is a leading healthcare intelligence company that delivers value, transparency, and efficiency to health plan clients. Deployed by over 85 health plans representing more than 270 million lives, the company uses an AI-powered platform and best-in-class expertise to reimagine healthcare.
Lead clinical excellence managers in their region through account management and customer success.
Partner with customers to ensure highest standards of patient care and drive long-range sales plan.
Collaborate with cross-functional teams to align clinical strategies with company objectives.
Outset Medical is a trailblazing medical device company that is revolutionizing dialysis by pioneering groundbreaking technology. They focus on creating a high-performing team obsessed with progress in an atmosphere of transformative opportunities.