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 case management addressing medical, social, psychological, physical, and spiritual needs of members.
Develop, implement, and monitor care plans in collaboration with PCP, caregivers, and team members.
Ensure members' needs are met through coordinated care and support.
Elderplan offers Medicare and Medicaid managed care health plans designed to keep members independent and living life on their own terms. As part of MJHS, it is a supportive community committed to excellence, respect, and high-quality personalized health care services.
Perform case reviews and process requests for elective services and durable medical equipment.
Collaborate with physicians, vendors, and providers to ensure regulatory compliance and timely service.
Provide high-quality customer service to members and healthcare professionals.
Elderplan provides Medicare and Medicaid managed care health plans designed to help people stay independent. They are part of MJHS, a supportive community committed to excellence, respect, and collaboration.