Partner across five New Jersey hospice offices to support clinical quality, consistency, and regulatory readiness
Provide documentation support, clinical guidance, and education to office Clinical Managers and field clinicians
Participate in quality improvement activities and help prepare teams for audits, surveys, and operational reviews
BAYADA HOME HEALTH CARE is a nonprofit, leading home health care company. They believe their clients and their families deserve care delivered with compassion, excellence, and reliability. They are celebrating 50 years of compassion, excellence, and reliability.
Manages medical denials by conducting a comprehensive analytic review of clinical documentation to determine if an appeal is warranted.
Utilizes clinical background to address the clinical denials, as well as write sound, compelling factual arguments for appealing denials.
Responsible for maintaining a detailed knowledge of Third Party Payors and Governmental Payors clinical/medical necessity criteria, as well as filing compliant appeals.
Shriners Children’s respects, supports, and values each other. They are engaged in providing excellence in patient care, embracing multi-disciplinary education, and research with global impact and were named as the 2025 best mid-sized employer by Forbes.
Perform telephonic symptom assessment and triage using evidence-based protocols to ensure appropriate care and disposition.
Document patient interactions accurately in the EMR and educate callers on virtual care, provider referrals, and available community resources.
Deliver excellent customer service while maintaining confidentiality, sound judgment, and effective communication with diverse populations.
UnityPoint Health is committed to team members and has been recognized as a Top 150 Place to Work in Healthcare by Becker's Healthcare. They champion a culture of belonging where everyone feels valued and respected, honoring the ways people are unique and embracing what brings us together.
Review and process appeals submitted by members and providers, ensuring timely and accurate resolution.
Evaluate cases, determine next steps, and manage multiple priorities while meeting strict turnaround times.
Review clinical and medical records, summarize findings for Medical Director review, and operate within turnaround times as short as 24–72 hours.
BlueCross BlueShield of Tennessee has been helping Tennesseans find their own unique paths to good health since 1945. At BCBST, they empower their employees to thrive both independently and collaboratively, creating a collective impact on the lives of their members.
Performs activities related to insurance company notifications and obtaining certifications/authorizations related to Utilization Review.
Communicates clinical information and updates to insurance companies as requested or required to justify medical necessity.
Liaises with third-party payers regarding UR requirements and assists with complex authorization needs impacting patient transition planning.
Phoebe Putney Health System is southwest Georgia’s preferred career choice for professionals who want to improve the community’s health by joining a respected, cutting-edge team. They are one of the area’s premier employers, offering a close-knit culture, outstanding benefits and many ways to develop your career.
Coordinate care and collaborate with multiple disciplinary team members to improve the quality of care and clinical outcomes.
Conduct thorough assessments to determine unmet needs and develop individualized care plans.
Promote quality cost-effective outcomes with the goal of improved care coordination.
Dignity Health Medical Foundation works hand-in-hand with physicians and providers throughout California to provide comprehensive health care services. They strive to create purposeful work settings where staff can provide great care, while advancing in knowledge and experience through challenging work assignments and stimulating relationships.
Conduct initial and follow-up telehealth assessments, initiating/adjusting plans of care, and coordinating with providers via a secure platform.
Interpret insights from the Circadia platform to prioritize high-risk patients, driving timely interventions to prevent decline and unnecessary ED visits.
Complete documentation/charts within the same day, efficiently completing 25+ tele visits per day for home health patients in the SoCal/OC area.
Circadia Health is a healthcare AI company focused on preventing avoidable hospitalizations and transforming senior-care operations. They have a platform that combines contactless sensing with predictive models and enterprise integrations, touching 40,000+ post-acute patients daily.
Responsible for conducting monthly clinical check-ins, identifying and addressing clinical concerns.
Reinforcing care plans, escalating issues appropriately, and ensuring clinical documentation accuracy.
Supporting patients between office visits while collaborating closely with Evergreen’s providers, care teams, and leadership.
Evergreen Nephrology partners with nephrologists to transform kidney care through a value-based, person-centered, holistic, and comprehensive approach to kidney care. They are committed to improving patient outcomes and improving quality of life.
Conduct responsible and compassionate psychiatric assessments, diagnoses, treatment planning, medication management, and referrals.
Prescribe, titrate, refill, and monitor psychotropic medications across major medication classes.
Partner closely with therapists, MDs, NPs, PAs, acupuncturists, mental health leads, and clinical leaders to support coordinated, patient-centered care.
Tia is building a new model for women’s healthcare by integrating primary care, mental health, gynecology, and wellness across in-person and virtual settings. They are a Series D, venture-backed company, and they focus on creating a culture of excellence in people, process, and product.
Pulling, sorting, and analyzing data to determine member eligibility for the Population Health management Program.
Coordinating and providing care that is timely, effective, equitable, safe, and member-centric while following HMO processes.
Managing case assignments which includes outreach, documentation, monitoring for case progression, and case closure.
Guidehealth is a data-powered healthcare company dedicated to operational excellence. They aim to make healthcare affordable, improve patient health, and restore fulfillment in practicing medicine. Guidehealth is a growing and innovative organization and employees are expected to adapt to evolving business needs.