Conduct clinical reviews of medical records during fraud investigations and program integrity initiatives.
Apply Medicare and Medicaid guidelines to determine appropriateness of payment coverage.
Compile investigative summary reports and provide training on medical terminology and policy interpretation.
CoventBridge Integrity Systems delivers investigative services, technology, and expertise that help healthcare and government organizations protect critical programs, strengthen oversight, and address fraud, waste, abuse, and operational risk. They are an equal opportunity employer committed to diversity and inclusion, maintaining a drug-free workplace.
Provide high-quality nursing care and study procedures to clinical trial participants in their homes.
Enjoy flexible, project-based PRN work with paid travel time and mileage reimbursement.
Work independently, travel 1-2 hours to patient homes, and support protocol compliance.
WEP Clinical partners with biopharma sponsors to deliver clinical trials and home health services, improving patient access. With 15+ years and 150+ countries' reach, it values integrity, accountability, and inclusion.
Review, investigate, and appeal denied hospital insurance claims using clinical documentation and payer policies.
Develop evidence-based appeal letters addressing medical necessity, level-of-care, and charge discrepancies.
Collaborate with nursing, revenue integrity, and financial teams to resolve denials and prevent future rejections.
This partner company is a healthcare system that provides hospital services and focuses on revenue integrity. It supports fully remote work and values clinical expertise, collaboration, and financial sustainability.
Deliver comprehensive, coordinated health services remotely using telehealth and digital tools.
Assess patients' medical, physical, and psychological status and develop interdisciplinary care plans.
Support enterprise-wide Virtual Health Services implementation, including travel to hospitals for expansions.
CommonSpirit Health is a nonprofit Catholic healthcare organization providing integrated health services and virtual care across 24 states. With over 157,000 employees and 45,000 nurses, it fosters a culture of humankindness and delivers more than 20 million patient encounters annually.
Lead, coach, and onboard Utilization Management nurses while managing daily workloads and escalations.
Ensure reviews and determinations are timely, accurate, and compliant with CMS and Clover policies.
Collaborate with Medical Directors and cross-functional teams to improve workflows and member outcomes.
Clover Health provides data-driven healthcare plans for seniors, using the Clover Assistant to support physician decisions. The company is a mission-driven team of diverse experts focused on improving members' quality of life.
Review lab results issued through Maple and assign appropriate follow-up recommendations for patients.
Contact patients directly when critical results require immediate emergency care and escalate complex cases to physicians.
Support specialist referrals, prepare documentation, and review consult reports to ensure timely follow-up.
Maple is Canada's leading on-demand healthcare platform, connecting patients with Canadian-licensed doctors, nurse practitioners and specialists. With over 8 million patients and 7,000 business and government partners, Maple empowers bold thinking and an inspiring team culture focused on making an impact.
Provide after-hours telephonic care and clinical direction to residents in senior living communities across multiple states.
Manage high call volumes, perform at least 30% telehealth visits, and evaluate acute changes, falls, and controlled substance visits.
Work from home with a set part-time schedule including weeknights, weekends, and holidays.
Curana Health is a national leader in value-based care for senior living communities and skilled nursing facilities, offering solutions such as on-site primary care, Accountable Care Organizations, and Medicare Advantage Special Needs Plans. Founded in 2021, the company serves over 200,000 seniors across 1,500+ communities in 32 states with a team of more than 1,000 clinicians and was ranked #147 on the Inc. 5000 list.
Provide comprehensive psychiatric evaluations and develop individualized treatment plans for children, teens, and young adults via telehealth.
Prescribe and manage psychotropic medications while monitoring effectiveness, safety, and clinical progress.
Collaborate with therapists, psychiatrists, and care coordinators through regular case consultation and maintain timely documentation in the EHR.
Backpack Healthcare provides accessible mental health care to children, teens, and young adults through telehealth. They are a clinician-led, minority-owned company that has served 12,000+ families since 2020, with a collaborative and supportive culture.
Conduct thorough patient assessments and develop personalized treatment plans via video visits.
Collaborate with a multidisciplinary care team to deliver the highest standards of care.
Educate patients on preventive care and wellness using evidence-based strategies.
Allara is a comprehensive women's health provider offering expert, longitudinal care for hormonal, metabolic, and reproductive conditions. It is a fast-growing U.S. platform trusted by thousands, with an inclusive, collaborative culture.
Conduct comprehensive psychiatric evaluations, treatment planning, and medication management for children, adolescents, and young adults.
Build meaningful relationships with patients and families to support engagement and educate on care options.
Collaborate with an interdisciplinary team of psychotherapists and specialists to deliver evidence-based, whole-child care.
Blackbird Health is a clinician-founded, owned, and operated company providing virtual and in-person mental health services for children in the Mid-Atlantic U.S. Their collaborative, supportive team takes a whole-child approach to care.