Serve as the primary point of contact for patients and providers, managing inbound inquiries and conducting outbound outreach for program enrollment and clinical quality checks. Educate customers on healthcare benefits and resolve complex issues through cross-departmental collaboration.
Guidehealth
23 Remote Job Openings at Guidehealth
Medical Contact Center Representative, Inside Sales
Guidehealth
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Full Time
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10 days ago
Guidehealth
Serve as the primary point of contact for patients and providers, handling inbound inquiries and conducting outbound outreach for program enrollment and clinical quality checks. Educate customers on healthcare benefits and resolve complex issues while ensuring strict adherence to HIPAA and privacy regulations.
Healthcare Contact Center Representative, Inside Sales
Guidehealth
·
Full Time
·
10 days ago
Guidehealth
Serve as the primary point of contact for patients and providers, handling inbound inquiries and conducting outbound outreach for program enrollment and clinical quality checks. Educate customers on healthcare benefits and resolve complex issues through cross-departmental collaboration.
Lead a team of Clinical Compliance Auditors and Specialists to ensure adherence to UM and PHM plan requirements. Serve as a clinical liaison to senior management and oversee the reporting of utilization management data to the IPA UM Committee.
Registered Nurse (RN) - Telehealth Medicare Annual Wellness Visit Specialist - PRN
Guidehealth
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Full Time
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12 days ago
Guidehealth
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.
Registered Nurse (RN) - Telehealth Medicare Annual Wellness Visit Specialist - PRN
Guidehealth
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Full Time
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12 days ago
Guidehealth
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.
Registered Nurse (RN) - Telehealth Medicare Annual Wellness Visit Specialist - PRN
Guidehealth
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Full Time
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12 days ago
Guidehealth
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.
Remote Clinical Pharmacist – HEDIS Medication Adherence
Guidehealth
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Full Time
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13 days ago
Guidehealth
Lead efforts to improve HEDIS medication adherence and pharmacy quality measures through data analysis and targeted interventions. Conduct medication therapy management sessions and collaborate with healthcare providers to resolve barriers to patient adherence.
Remote Clinical Pharmacist – HEDIS Medication Adherence
Guidehealth
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Full Time
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13 days ago
Guidehealth
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.
Remote Clinical Pharmacist – HEDIS Medication Adherence
Guidehealth
·
Full Time
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13 days ago
Guidehealth
Lead efforts to improve HEDIS medication adherence rates by analyzing data and implementing targeted interventions. Conduct medication therapy management sessions and collaborate with healthcare providers to resolve barriers to patient adherence.
Remote Clinical Pharmacist – HEDIS Medication Adherence
Guidehealth
·
Full Time
·
13 days ago
Guidehealth
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 patient barriers to medication 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.
Supervise day-to-day operations of clinical compliance auditors and specialists while serving as a liaison to senior management. Oversee utilization management data reporting and ensure adherence to clinical auditing guidelines and denial processes.
Acts as a bridge between patients, providers, and community resources to help patients overcome barriers to care and improve health outcomes. Responsibilities include conducting non-clinical assessments, coordinating follow-up care, and documenting interactions within EHR systems to support value-based care goals.
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.
The Care Manager builds relationships with patients to create personalized care plans addressing medical, behavioral, and social needs. They coordinate care across providers and use data to identify opportunities for improving patient outcomes.
Utilization Management Registered Nurse (RN) - Remote
Guidehealth
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Full Time
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a month ago
Guidehealth
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.
The Care Manager builds relationships with patients to create personalized care plans addressing medical, behavioral, and social needs. They coordinate care across providers and use data to identify opportunities for improving patient outcomes.
Own the end-to-end lifecycle of the Rose conversational automation tool, scaling its capabilities across clinical operations. Partner with cross-functional teams to identify requirements, manage the product roadmap, and ensure regulatory compliance.
Partner with clinical operations to identify and prioritize requirements for AI-powered use cases while managing the project lifecycle from development to deployment. Analyze performance data and conduct audits to ensure clinical accuracy and regulatory compliance.
Partner with clinical operations to identify and prioritize requirements for AI-powered use cases while managing the project lifecycle from development to deployment. Analyze performance data and conduct audits to ensure clinical accuracy and regulatory compliance.
Build relationships with patients to create personalized care plans addressing medical, behavioral, and social needs. Coordinate care across providers and use data to identify opportunities for improving patient outcomes.
Act as a trusted guide for patients by creating personalized care plans that address medical, behavioral, and social needs. Coordinate care across providers and settings to ensure safety, quality, and continuity of health outcomes.
