The Clinical Compliance Auditor II conducts comprehensive audits of utilization management and clinical operations to ensure adherence to regulatory and contractual standards. This role also provides leadership through mentorship, process improvement, and the development of compliance monitoring frameworks.
The intake coordinator reviews and approves routine referrals and pre-certifications while managing clerical support and data entry tasks. They also assist physician offices with inquiries and collaborate with clinical and claims departments to ensure compliance and accuracy.
The Clinical Compliance Auditor II ensures clinical operations and utilization management activities comply with regulatory requirements and contractual obligations. This role also performs advanced audits, mentors staff, and collaborates with leadership to identify risks and improve clinical compliance infrastructure.
The Clinical Compliance Auditor II conducts comprehensive audits to ensure clinical operations and utilization management activities comply with regulatory and contractual standards. This role also provides mentorship to staff, identifies operational risks, and collaborates with leadership to improve compliance infrastructure.
The Client Business Manager owns client onboarding, operational support, and service delivery for assigned accounts. They are responsible for managing delegated services, ensuring contract compliance, and driving performance metrics to meet organizational goals.
The Client Business Manager oversees client onboarding, operational support, and service delivery to ensure seamless operations and high-quality outcomes. They act as the primary point of accountability for delegated functions, managing performance metrics and maintaining strong relationships with client stakeholders.
The Clinical Pharmacist will lead efforts to improve HEDIS medication adherence rates and conduct medication therapy management sessions to address patient barriers. They will also analyze performance data, implement targeted interventions, and collaborate with healthcare providers to drive quality outcomes.
The Retinal Camera Operator is responsible for traveling to provider practices to perform scheduled diabetic eye exams using company-provided imaging equipment. They must manage daily appointment schedules, maintain strong relationships with healthcare teams, and ensure accurate documentation of quality gaps.
The Care Manager will build meaningful relationships with patients to create personalized care plans that address medical, behavioral, and social needs. They will coordinate care across providers and settings while educating members to navigate the healthcare system effectively.
Conduct Medicare Annual Wellness Visits via telehealth while ensuring accurate documentation and patient education. Collaborate with supervising physicians to manage personalized prevention plans and monitor patient health outcomes.
Conduct Medicare Annual Wellness Visits via telehealth platforms while ensuring accurate documentation and patient education. Collaborate with supervising physicians to develop personalized prevention plans and monitor patient health outcomes.
Conduct Medicare Annual Wellness Visits via telehealth while ensuring accurate documentation and patient education. Collaborate with physicians to develop personalized prevention plans and monitor patient health outcomes.
The RN Case Manager will manage member care by performing clinical reviews, behavioral health assessments, and data analysis to promote wellness and health-autonomy. They will coordinate care, facilitate member outreach, and ensure documentation compliance with regulatory and company standards.
Conduct Medicare Annual Wellness Visits via telehealth while ensuring accurate documentation and patient education. Collaborate with physicians to assess health risks and monitor patient progress through virtual consultations.
Conduct Medicare Annual Wellness Visits via telehealth platforms while ensuring accurate documentation and patient education. Collaborate with supervising physicians to develop personalized prevention plans and monitor patient health outcomes.
Conduct Medicare Annual Wellness Visits via telehealth while providing patient education and personalized prevention plans. Collaborate with physicians to maintain accurate medical records and ensure compliance with CMS guidelines.
The Retinal Camera Operator performs scheduled diabetic eye exams at provider practices using company-provided imaging equipment. The role involves managing a daily travel schedule, coordinating logistics, and maintaining strong relationships with healthcare partners.
The Retinal Camera Operator is responsible for traveling to provider practices to perform diabetic eye exams using specialized imaging equipment. They must manage a daily appointment schedule, coordinate travel logistics, and maintain strong relationships with healthcare providers and patients.
Perform scheduled diabetic retinal screenings at provider practices using company-provided imaging equipment. Manage daily appointment schedules, coordinate travel logistics, and maintain strong relationships with healthcare providers and care teams.
The Retinal Camera Operator performs scheduled diabetic eye exams at provider practices using company-provided imaging equipment. They are responsible for managing appointment schedules, coordinating travel logistics, and maintaining strong relationships with healthcare teams.
Perform scheduled diabetic retinal screenings at provider practices using company-provided imaging equipment. Manage daily appointment schedules and coordinate travel logistics while maintaining strong relationships with healthcare providers and patients.
The Retinal Camera Operator is responsible for traveling to provider practices to perform diabetic eye exams using specialized imaging equipment. They must manage a daily appointment schedule and coordinate logistics while maintaining strong relationships with care teams and patients.
The Healthguide serves as a bridge between patients, medical providers, and clinical teams to navigate care systems and improve health outcomes. This role involves proactive patient outreach, clinical documentation, and coordinating resources to support whole-person health within a value-based care model.
The Healthguide serves as a bridge between patients and healthcare providers, facilitating care coordination and addressing medical, social, and behavioral needs. This role involves proactive patient engagement, documentation in electronic health records, and supporting value-based care performance through quality measure achievement.
Conduct Medicare Annual Wellness Visits via telehealth to assess health risks and provide preventive education. Collaborate with physicians to update medical histories and develop personalized prevention plans for Medicare patients.
Conduct Medicare Annual Wellness Visits via telehealth to assess health risks and provide preventive care education. Collaborate with physicians to update medical histories and develop personalized prevention plans for Medicare patients.
Conduct Medicare Annual Wellness Visits via telehealth to assess health risks and provide preventive education. Collaborate with physicians to update medical histories and maintain accurate patient records in compliance with HIPAA.
Lead efforts to improve HEDIS medication adherence rates by analyzing data and implementing targeted interventions. Conduct MTM sessions and collaborate with healthcare providers to resolve barriers to patient adherence.
Act as a Subject Matter Expert on quality improvement measures to identify and close quality gaps through patient outreach and data collection. Manage quality data using EMRs and payer portals while communicating performance and improvement strategies to stakeholders.
The role focuses on onboarding clinical and claims data and managing technical implementation projects with healthcare vendors. This includes designing data flow diagrams, translating operational requirements into technical workflows, and performing data QA.
Perform utilization reviews and clinical determinations using medical necessity criteria to ensure compliant healthcare services. Collaborate with medical directors and providers while integrating AI tools into the daily clinical workflow.
