The Enterprise Sales Director will own and grow the Southeast territory by developing strategic plans to acquire new clients and drive revenue. They will lead full-cycle sales processes, from prospecting to contract execution, while building trusted relationships with executive decision-makers.
Personify Health
6 Remote Job Openings at Personify Health
The RN UM Team Lead manages a clinical team to ensure consistent application of medical-necessity criteria and timely coverage decisions. They monitor workflow health, audit documentation for quality, and coach staff to improve clinical rationale and regulatory compliance.
The Senior Account Manager will serve as the primary operational point of contact for high-value TPA clients, ensuring service commitments are met and operational issues are resolved. They will lead cross-functional teams to address escalations, drive root-cause investigations, and manage the overall client program lifecycle.
Perform utilization management and medical-necessity reviews to determine appropriate levels of care based on evidence-based criteria. Manage the appeals process, document clinical rationales, and ensure compliance with regulatory and accreditation standards.
The Utilization Review Nurse performs first-level clinical reviews to assess the medical necessity of pre-certification and post-service requests. They also manage the appeals process, coordinate patient discharges, and ensure documentation meets evidence-based clinical standards.
Conduct medical-necessity reviews using evidence-based criteria to determine appropriate levels of care for members. Manage caseloads by prioritizing urgency and regulatory deadlines while documenting all rationales for audit trails.