Review medically complex claims, pre-authorization requests, appeals, and fraud/abuse referrals.
Assess payment determinations using clinical information and established guidelines.
Evaluate medical necessity, appropriateness, and reasonableness for coverage and reimbursement.
Broadway Ventures delivers tailored solutions that drive operational success, sustainability, and growth for government and private sector clients. As an 8(a), HUBZone, and Service-Disabled Veteran-Owned Small Business (SDVOSB), they empower clients with expert program management, cutting-edge technology, and innovative consulting solutions.
Nurse conducts clinical review of cases not meeting criteria by performing clinical intake.
Adjudicates (closes), requests additional clinical information or escalates to Medical Directors.
Active PRC and USRN License required with 2 years Bedside Experience.
WNS, part of Capgemini, is an Agentic AI-powered leader in intelligent operations and transformation, serving more than 700 clients across 10 industries. With 66,000 employees, WNS combines scale, expertise and execution to create meaningful, measurable impact.
Conduct new patient visits via telemedicine, focusing on chronic condition management.\n- Collaborate with RNs to develop individualized care plans tailored to patients' needs.\n- Perform telemedicine visits for ailments experienced by residents in senior living communities.
Red Cell Partners is an incubation firm building and investing in rapidly scalable technology-led companies that are bringing revolutionary advancements to market in healthcare, cyber, and national security. United by a shared sense of duty and deep belief in the power of innovation, Red Cell is developing powerful tools and solutions to address our Nation’s most pressing problems.
Coordinate with Front Desk Coordinators to manage house call requests and assist with patient care in the clinic.
Formulate a differential diagnosis and treatment plan for urgent and emergent care in non-clinic settings.
Document clinical evaluations and treatments accurately in the electronic health record (AthenaHealth).
Sollis Health is a medical membership that’s on-demand 24/7, 365. They provide concierge care and follow-up with ER-trained medical teams, on-site labs and imaging, expedited specialist appointments, and care navigation. With locations in multiple states.
Vira Health is on a mission to extend healthy life expectancy for women, starting with menopause. Their virtual clinic, Stella, combines evidence-based care, expert clinicians, and personalized support to help women manage symptoms and improve long-term health outcomes.
Accept insurance hassle-free by credentialing you with the nation’s largest networks and handling the billing and admin paperwork for you.
Maintain a flexible schedule by deciding how many clients you see through Headway, so that you can set the hours that work for you.
Grow your caseload by providing marketing support and best practices to grow your practice!
Headway is building a new mental healthcare system that everyone can access by solving the biggest barrier to care: insurance. Over 75,000 providers across all 50 states run their practice on our software, serving over 1 million patients.
Provides nursing assessments within the standards outlined in the state Nurse Practice Act.
Provides clinical assessments and health education using telecommunications in accordance with protocols and guidelines.
Uses the nursing process to identify patient care needs, risk and safety issues, and appropriate health care referrals.
Carenet Health delivers patient-centric healthcare solutions. We foster a collaborative team of RNs across the country and are committed to creating an inclusive environment for all employees.
Handle calls and respond appropriately within their scope of practice.
Coordinate telehealth meetings between participants and clinicians and ensure timely care delivery.
Troubleshoot logistical care delivery issues and support smooth care transitions between settings.
WelbeHealth PACE helps seniors stay in their homes and communities by providing comprehensive medical care and community-based services. They serve the most vulnerable seniors with better quality and compassion in a value-based model, showing they care about their team members and offer great benefits.
Handle calls (inbound/outbound) as assigned, responding as appropriate within their scope of practice, and consulting with other clinicians, including on-call providers
Coordinate telehealth meetings between participants and clinicians
Support the clinical care and home health teams to manage smooth care transitions between settings (hospitals, skilled nursing facilities, etc.), escalating changes in participants’ conditions as appropriate
WelbeHealth PACE helps seniors stay in their homes and communities by providing comprehensive medical care and community-based services. The company serves the most vulnerable seniors with better quality and compassion in a value-based model.
Conduct thorough patient assessments and develop personalized treatment plans via video visits.
Collaborate with a multidisciplinary team to deliver the highest standards of care.
Complete required training and adhere to company policies and best practices.
Allara is a comprehensive women’s health provider specializing in longitudinal care for women through every life stage. They connect patients with multidisciplinary care teams with a deep understanding of hormonal, metabolic, and reproductive care. Allara is one of the fastest-growing women’s health platforms in the U.S.