Coordinate and provide care that is timely, effective, and member-centric while following HMO processes.
Manage case assignments including outreach, documentation, monitoring for case progression, and case closure.
Assist members in reaching wellness by addressing barriers, social determinants, and psychosocial issues.
Guidehealth is a data-powered healthcare company dedicated to making great healthcare affordable and improving patient outcomes. It is a physician-led, performance-driven organization with a culture of empathy, accountability, and continuous learning.
Review medical records to develop concise clinical reviews supporting authorization and reimbursement.
Facilitate communication with payors to ensure appropriate utilization management decisions.
Collaborate with interdisciplinary team to prevent denials and optimize patient care.
West Virginia University Health System is West Virginia’s largest health system, providing comprehensive healthcare services. With over 35,000 employees and 25 hospitals, it is the state's largest employer and offers a collaborative, patient-centered culture.
Conduct comprehensive clinical assessments and provide triage, support, and education to cancer patients via phone and email.
Collaborate with nurse leaders and medical directors to ensure alignment with clinical protocols and best practices.
Establish trusting relationships with members and their care network, prioritizing empathy and active listening in every interaction.
Thyme Care is a value-based oncology care enabler that partners with health plans, providers, and employers to improve outcomes and lower costs for people with cancer. It is a tech-native organization with a mission-driven culture focused on human connection and innovation.
Define and maintain clinical standards for home visits, including medication administration, infusion practices, and patient assessment.
Investigate adverse events and near misses, conduct root cause analyses, and implement corrective actions.
Collaborate cross-functionally to integrate clinical quality into product development, analytics, and compliance.
They provide home-based specialty pharmacy and infusion care services. They are a rapidly scaling healthcare technology company focused on quality, patient safety, and cross-functional collaboration.
Provide clinical education, focused interventions, and care transition support for members with low-acuity needs.
Conduct in-person and virtual clinical exams, medication reconciliation, and chart reviews.
Triage referrals and collaborate with care team to ensure timely follow-up and handoffs.
Cityblock Health is a tech-driven provider for communities with complex needs, offering personalized primary care, behavioral health, and social services. Founded in 2017 and backed by Alphabet, the company has a diverse, inclusive culture and is growing rapidly.
Review medical history with patients in preparation for prescriber review.
Provide patient counseling on medication use, safety, and side effects.
Collaborate with the Customer Experience team and medical network to coordinate care.
Remedy (formerly Thirty Madison) revolutionizes healthcare accessibility by providing remote care and support. The company is building a diverse and inclusive workplace as part of a larger organization.
Review Home Health prior authorization requests using CMS guidelines and clinical judgment.
Lead and mentor the Home Health UM nursing team, ensuring quality and compliance.
Collaborate with cross-functional partners to optimize care and improve utilization.
Clover Health provides high-quality, affordable healthcare for America's seniors by combining data, technology, and preventive care. They are a mission-driven team with diverse expertise, focused on improving members' lives through innovation and empathy.
Provide direct clinical support to patients undergoing medication abortion through telemedicine.
Respond to medical questions, deliver triage, clinical assessment, and nursing guidance.
Ensure patients feel heard, supported, and cared for with trauma-informed, culturally responsive care.
Hey Jane provides safe, discreet medication abortion treatment and reproductive health services via telemedicine. They have helped over 100,000 people, with a clinical care team of board certified doctors, advanced practice clinicians, nurses, and patient care advocates.
Manage a portfolio of clients, providing clinical support, education, advocacy, and care coordination throughout their healthcare journey.
Conduct clinical intakes, collaborate with internal teams, and ensure smooth transitions across care delivery.
Communicate clearly and compassionately with clients, caregivers, providers, and internal partners.
Private Health Management guides patients and families through serious medical care, acting as an independent advocate to orchestrate the best treatment and support. The company is a mission-driven organization with a team of experts that provides compassionate, high-quality care coordination.
Applies approved utilization criteria to monitor appropriateness of admissions and continued stay reviews.
Communicates with third-party payers for initial and concurrent clinical review to ensure medical necessity.
Tracks length of stay and resource utilization to identify at-risk patients and supports appeals on denied cases.
University of Utah Health is a patient-focused healthcare organization dedicated to enhancing health and well-being through patient care, research, and education. It is a nationally ranked Level 1 Trauma Center with five hospitals and eleven clinics, fostering a culture of collaboration, excellence, and respect.