Review a variety of claim types including Radiology, Ambulance, Physical Therapy, and Surgical for medical necessity and coverage.
Document medical rationale for payment or denial decisions using Medicare guidelines and established criteria.
Educate internal and external staff on medical review, terminology, coverage determinations, and coding.
We transform challenges into opportunities with expert program management, cutting-edge technology, and innovative consulting solutions. As an 8(a), HUBZone, and Service-Disabled Veteran-Owned Small Business, we are built on integrity, collaboration, and excellence.
Coordinate clinical appointments, manage referrals, and proactively follow up with families to reduce gaps in care.
Provide evidence-based education to families on chronic condition management, medication regimens, and treatment plans.
Manage medication prior authorizations, coordinate with pharmacies, and document clinical interactions across EHR platforms.
Clarity Pediatrics is reimagining pediatric chronic care, starting with ADHD and expanding to obesity and overweight management. The company is a fast-growing startup with a leadership team committed to clinical excellence and a remote-friendly culture.
Manage patient flow, triage, and direct patient care in an ambulatory cardiology clinic.
Coordinate continuity of care and communicate with patients, families, and physicians to ensure understanding of the plan of care.
Navigate new cardiology patients by obtaining records, preparing charts, and scheduling visits.
The University of Kansas Health System is a world-class academic medical center in Kansas City providing complex care and diagnosis. It fosters a collaborative culture of physicians, nurses, researchers, and educators advancing life-changing treatments.
Acts as a patient advocate coordinating transitions to the next level of care per regulations and agency policies.
Collaborates with MJHC and inpatient facilities to evaluate inpatients for transitional planning and home health services.
Uses telephonic outreach with discharge planners and case managers for Elderplan's SNP.
Elderplan and HomeFirst are Medicare and Medicaid managed care health plans under MJHS, offering personalized care to help people remain independent. MJHS fosters a collaborative culture focused on excellence, respect, work-life balance, and career development.
Provide palliative care and advance care planning via phone, email, and video for members with serious illness.
Conduct comprehensive symptom assessments and facilitate end-of-life care discussions with the care team.
Support members and their care networks, manage clinical escalations, and collaborate with payers and providers.
Thyme Care is a value-based oncology care enabler partnering with health plans, providers, and employers to improve outcomes and lower costs for cancer patients. It is a tech-native organization that combines high-touch human support with technology and AI to make cancer care more connected and compassionate.
Provide virtual gynecology and reproductive health care for women via telehealth.
Deliver patient-centered, trauma-informed care while collaborating with Tia's multidisciplinary team.
Use technology and data to improve clinical decision-making and virtual care pathways.
Tia is building a new model for women's healthcare that integrates primary care, mental health, gynecology, and wellness across in-person and virtual settings. Tia is a Series D, venture-backed company trusted by more than 120,000 women across four markets.
Provide psychiatric evaluations, medication management, and ongoing care for Medicaid patients.
Enjoy full flexibility with your own hours, caseload, and preferred referrals.
Work remotely with administrative support and a robust referral network.
Third Space Therapy expands Medicaid-covered behavioral healthcare by combining private-practice independence with group support. They handle administrative tasks like billing and credentialing, allowing clinicians to focus on care.
Provide 100% remote outpatient psychiatric care to lower-to-moderate acuity populations.
Manage standard sessions including 60-minute intakes and 30-minute follow-ups with full operational support.
Maintain clinical autonomy over schedule and patient population without pressure to increase volume.
Talkiatry is a clinician-led virtual psychiatry practice that combines the stability of a hospital practice with clinical autonomy for its providers. The company supports a collaborative culture with over 800 psychiatrists and PMHNPs and more than 300 therapists practicing across 32 languages.
Conduct patient intake and follow-up consultations via telemedicine to evaluate eligibility for ketamine-assisted psychotherapy.
Prescribe and monitor treatment outcomes, adjusting plans based on patient response in collaboration with psychotherapists.
Provide feedback to improve the care management system and report directly to the Lead Clinician.
Journey Clinical is a healthtech platform expanding access to psychedelic-assisted psychotherapy, starting with ketamine-assisted psychotherapy. They are a mission-driven, inclusive startup backed by top-tier investors, with a collaborative team of high-performing individuals.
Conduct initial and follow-up telehealth evaluations for substance use and mental health conditions.
Prescribe medications, including Suboxone for opioid use disorder, and respond to member questions.
Complete timely documentation in EHR (Healthie) and collaborate with care team in scheduled meetings.
Affect is transforming behavioral health care by combining mobile technology with counseling and medical services to deliver 100% virtual, evidence-based treatment. They are a mission-driven, collaborative team focused on meaningful, outcomes-based care.