Serves as a patient advocate and navigator, guiding patients and caregivers through the healthcare system.
Completes emergency room and hospital follow-up calls, offering education on alternative access points to reduce avoidable ED visits.
Facilitates medication education and adherence support, including alignment with standing orders, protocols, and chronic disease management goals.
Praxis Health is a family of medical groups providing high-quality healthcare throughout the state of Oregon. They are a company of small groups and clinics, of nimble micro-cultures that can quickly adapt to industry changes, as well as patient needs.
Conducts medical necessity reviews to determine appropriate patient class designation.
Performs timely reviews using InterQual Criteria and clinical nursing judgement.
Communicates with the provider team regarding patient class designation and medical necessity.
Emory Healthcare fuels professional journeys with benefits, resources, mentorship, and leadership programs. They offer a supportive environment for career growth.
Coordinate case management activities related to medication optimization, adherence, and therapeutic appropriateness
Collaborate with providers, PBMs, and pharmacy partners to support evidence-based medication use and access
Conduct member outreach, education, and follow-up to support adherence and understanding
Point C is a national third-party administrator (TPA) delivering customized self-funded benefit programs with local market presence. They focus on cost containment strategies with innovative solutions. They are driven by a clear and impactful mission.
Conduct targeted patient outreach to close care gaps and ensure timely care transitions.
Deliver high-touch engagement for high-risk patients to prevent readmissions through follow-up.
Collaborate with Practices to support interventions such as Transitional Care Management.
Aledade empowers independent primary care practices, helping them deliver better care and thrive in value-based care. Founded in 2014, they are the largest network of independent primary care in the country with a collaborative, inclusive, and remote-first culture.
Assess, plan, coordinate, and monitor patient care.
Develop, implement, and monitor individualized care plans.
Coordinate care across providers, facilities, and community resources.
Limitlessli specializes in recruiting, hiring, and managing high-caliber remote staff for dynamic and growing healthcare facilities. They connect clients with highly qualified professionals, offering tailored services to meet unique business needs, leveraging an extensive global network.
Coordinate and implement medical case management to facilitate case closure.
Assess appropriate utilization of medical treatment and services.
Review medical records and assess data to ensure appropriate case management process.
Berkley Medical Management Solutions (BMMS) provides managed-care service for W.R. Berkley Corporation, focusing on injured worker’s return to work. BMMS was started in 2014 and combines clinical practices, return-to-work strategies, and software for workers’ compensation cases.
Collaborate with hospitals, rehabs, and SNFs to manage patient’s inpatient stay and desired discharge plan
Communicate effectively with internal and external stakeholders in order to promote Bluestone’s mission and maintain patient health
Help reduce unnecessary visits to the emergency departments as to acute settings with the goal of reducing utilization and unnecessary costs
Bluestone delivers great outcomes by bringing exceptional care to patients living with complex, chronic conditions and disabilities. Bluestone has been named to the Star Tribune's Top Workplace list for the 13th year in a row!
Responsible for the Care Coordination staff for case reviews and UR appeals.
Coordinates worklists and completion of cases on audit review, retro authorization and appeals.
Northside Hospital is an award-winning and state-of-the-art healthcare provider that is constantly growing. They are expanding the quality and reach of their care to patients and communities, creating more opportunity for healthcare professionals in Atlanta and beyond.
Manage a caseload and deliver exemplary member-centric care as part of the interdisciplinary team.
Deliver coaching and mentoring for quality improvement, best practices, and help drive performance.
Transcarent is the One Place for Health and Care, bringing medical, pharmacy, and point solutions together. More than 1,700 employers and health plans rely on them to provide information, guidance, and care, empowering health consumers with more choice and higher-quality care.
Contact patient and complete a thorough assessment, including physical, psychosocial, emotional, spiritual, environmental, and financial needs.
Develop treatment plan for standard and catastrophic cases in collaboration with the patient, caregivers or family, community resources and multi-disciplinary healthcare providers that include obtainable short- and long-term goals.
Advocate for the patient by facilitating the delivery of quality patient care, and by assisting in reducing overall costs; provide patient/family with emotional support and guidance.
Personify Health created the first and only personalized health platform—bringing health plan administration, holistic wellbeing solutions, and comprehensive care navigation together in one place. They serve employers, health plans, and health systems with data-driven solutions that reduce costs while actually improving health outcomes and have a mission to empower people to lead healthier lives.