Performs utilization review of cases to determine if the request meets medical necessity criteria in accordance with medical policies.
Collaborates with client personnel to resolve customer concerns and facilitates resolution of escalated cases.
Maintains written documentation per HealthHelp’s policy and ensures compliance with HIPAA, state, and federal regulations.
WNS, part of Capgemini, is an Agentic AI-powered leader in intelligent operations and transformation, serving more than 700 clients across 10 industries. With three global headquarters, operations in 13 countries, 65 delivery centers, and more than 66,000 employees, WNS combines scale, expertise, and execution to create meaningful, measurable impact.
Provide high-quality, evidence-based pediatric care via telehealth.
Work collaboratively with medical staff and customer support to ensure holistic patient care.
Practice with integrity and empathy, ensuring parents feel heard and children get great care.
Blueberry turns every family's living room into their own personal pediatric urgent care using home exam kits and AI-enabled pediatricians. They are a mission-driven company focused on improving access to pediatric care.
Serve as a clinical subject matter expert for UNLOXCYT, educating healthcare professionals on its mechanism of action, administration, safety, and clinical benefit.
Support infusion site readiness by training nursing staff, pharmacists, and advanced practice providers on product handling, adverse event management, and patient navigation.
Collaborate with commercial teams and utilize clinical insights to inform strategic account planning and national strategy.
EVERSANA delivers next-generation commercialization services to the life sciences industry, helping bring innovative therapies to market. With a global team of over 7,000 employees serving more than 650 clients, the company is grounded in cultural beliefs that foster an inclusive, patient-focused environment.
Perform utilization review including precertification and concurrent reviews using medical necessity criteria.
Collaborate with medical directors and providers on complex cases and integrate AI tools into workflow.
Initiate referrals to disease management programs and participate in quality improvement initiatives.
Guidehealth is a data-powered healthcare company that uses AI and predictive analytics to improve healthcare affordability and patient outcomes. It is a physician-led organization with a culture of accountability, learning, innovation, and empathy.
Provide high-quality psychiatric treatment and medication management for pediatric patients with anxiety and OCD.
Collaborate closely with board-certified child and adolescent psychiatrists and a multidisciplinary team.
Perform timely documentation, discharge planning, and participate in weekly treatment team meetings.
InStride Health delivers specialty anxiety and OCD care for children, teens, and young adults. They are a mission-driven company expanding insurance-based care with a dedicated multidisciplinary team.
Guide patients through the healthcare system by translating medical complexity into plain language and coordinating care.
Build and own care plans that address both medical needs and social determinants like transportation and food access.
Solve real problems with persistence by navigating denied claims, missed referrals, and unaffordable medications.
Careway Health is building an advocacy-first telehealth platform to help seniors overcome complex health and social challenges and maximize independence. They are a growing company focused on democratizing access to high-quality care with a team of physicians and health advocates.
Provide telephonic triage assessments and health education using nursing protocols and algorithms.
Utilize critical thinking and communication skills to manage diverse patient populations.
Work a flexible schedule that includes evenings and weekend shifts from your home office.
Carenet Health provides telephonic clinical assessments, health education, and utilization management services to patients and members. They are a growing organization with a collaborative national team of Registered Nurses, offering work-from-home options and a supportive culture.
Prepares patients for exams, administers medications, and assists with procedures in a physician office setting.
Coordinates care across settings, ensures labs and referrals are completed, and provides patient education.
Requires graduation from an accredited nursing program, RN licensure in Pennsylvania, and BLS certification.
Lehigh Valley Health Network is a nationally recognized health network with hospitals in Pennsylvania, ranked among the best by U.S. News. It employs nearly 20,000 healthcare professionals and is a Great Place to Work certified organization.
Performing clinical assessments, evaluations, and taking patient history.
Offering treatment options and guidance to patients on our platform.
Collaborating with care team and stakeholders to develop care plans.
Cloudcure is a fast-growing digital health startup with a mission to improve healthcare accessibility for all Canadians. The company has a small, growing team focused on pushing the boundaries of digital health with a culture that emphasizes professionalism, patient outcomes, and autonomy.
Deliver onsite clinical implementation, education, and go-live support for remote patient safety observation programs.
Execute implementation plans and provide instructor-led training to clinical staff and hospital leadership.
Collaborate with stakeholders to address implementation needs, resolve barriers, and support successful program adoption.
AvaSure is a pioneer in inpatient telehealth, providing safer environments with over 2 million patients monitored and 200 million monitored hours. The company fosters a diverse and inclusive work environment as an Equal Employment Opportunity employer.