Performs concurrent inpatient utilization review using InterQual criteria to determine if requests meet medical necessity criteria.
Engages in clinical collaboration with physicians, hospitalists, and care teams to obtain clinical information.
Maintains knowledge of regulations, accreditation requirements, and payer-specific guidelines.
WNS Healthhelp, part of Capgemini, is an Agentic AI-powered leader in intelligent operations and transformation, serving more than 700 clients across 10 industries. They bring together deep domain excellence with AI-powered platforms and analytics to help businesses innovate, scale, adapt and build resilience. With more than 66,000 employees, WNS combines scale, expertise and execution to create meaningful, measurable impact.
Provide first level review for all outpatient and ancillary pre-certification requests.
Work with hospital staff to prepare patients for discharge and ensure a smooth transition to the next level of care.
Complete documentation for all reviews in Eldorado/Episodes and maintain confidentiality.
Personify Health created a personalized health platform bringing health plan administration, holistic wellbeing solutions, and comprehensive care navigation together. Their team is on a mission to empower people to lead healthier lives.
Triages new patient appointments to the appropriate provider(s) and assures timely scheduling of initial appointments.
Assesses barriers to care and refers to support services, local, and national organizations when needed.
Educates on the treatment plan for patients based on diagnosis.
The University of Miami (UHealth) is South Florida's only university-based health system, providing leading-edge patient care powered by the ground breaking research and medical education at the Miller School of Medicine. With more than 17,000 faculty and staff, the University strives for excellence.
Reviewing cases, educating patients on appropriate care.
Managing health care costs for the dependents of our Nation’s Active Duty and eligible retirees.
Working remotely Monday through Friday, 8 hours per day.
Spectrum Healthcare Resources (SHR) delivers systems and processes designed to meet the unique needs of Military and VA Health Systems. They provide physician and clinical staffing and management services to United States Military Treatment Facilities and VA clinics.
Triage patient care needs over the phone, providing medical advice, and coordinating with healthcare providers to address urgent concerns.
Use motivational interviewing and active listening skills to understand patient needs and effectively communicate to identify/resolve issues.
Implement strategies to prevent hospital re-admissions, including patient education, follow up telephonic touchpoints, and care coordination.
VitalCaring is a leading provider of home health and hospice services. Founded in 2021, it has over 65 locations across the country and is committed to fostering a culture of support, growth, and excellence for its team.
Implement the population health framework for assigned customers to improve overall health and utilization patterns.
Develop and maintain knowledge of current customer contracts and performance guarantees.
Serve as a liaison between all parties to the population health initiative assigned.
Capital Blue Cross promises to go the extra mile for our team and our community. They have been consistently voted one of the “Best Places to Work in PA.”
Work remotely from home preparing surgical patients and anesthesia cases for their procedures.
Review history and physicals and consults for completeness, call patients reviewing history and provide instructions to prepare for surgery.
Add orders for day of surgery for anesthesia providers and work to communicate with OR schedulers, ambulatory and office staff.
UnityPoint Health is committed to its team members and has been recognized as a Top 150 Place to Work in Healthcare by Becker's Healthcare several years in a row. They champion a culture of belonging where everyone feels valued and respected.