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Conduct telephonic nursing assessments, develop and document care plans, and coordinate care, benefits, and post-discharge services with patients, families, clinicians, and community providers. Monitor patient outcomes, support self-management, ensure continuity of care, and contribute to department operations and training.
Coordinate patient support across members, emergency departments, and care teams, including outreach, calls, remote monitoring of emergency department journeys, and warm handoffs to clinical staff. Document interactions, enter member data, schedule appointments, provide administrative support, and follow applicable CMS, NCQA, and Model of Care requirements.
Provide virtual nutrition, fitness, and wellness coaching to employees enrolled in the Medical Weight Loss program, including personalized care guidance and group education. Collaborate with the medical and operations teams, advocate for employees seeking appropriate care and resources, and host activities that promote healthy living.
Design, configure, test, implement, and maintain clinical IT applications, while researching and resolving system and user issues. Collaborate with clinical departments and project teams to translate workflows into effective application solutions, document changes, support end users, and participate in on-call and maintenance activities.
Coordinate evidence-based, member-centered care for members with complex illnesses, ensuring members, providers, and internal care teams understand and follow comprehensive plans of care. Engage members and provider teams, establish accountability for care management resources, and design and implement targeted programs to support care goals and outcomes.
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Lead and develop Backup Care teams while overseeing daily shift operations, staffing, service metrics, member escalations, and consistent service delivery. Improve performance and workflows through data-driven coaching, operational process updates, adoption of new tools, and collaboration with cross-functional teams.
Conduct telehealth sessions, complete comprehensive patient assessments, and assist with treatment planning. Build meaningful client relationships, provide personalized care, and participate in monthly clinical case reviews.
Provide individual psychotherapy to adult clients via a secure telehealth platform while maintaining accurate clinical documentation. Collaborate with clinical and operational teams to develop treatment plans and participate in monthly case reviews.
Provides diagnosis-related nutrition education and individualized dietary plans, consulting with members, families, physicians, and multidisciplinary teams. Monitors and documents nutritional status and care plan progress, develops success measures, and coaches members toward self-management goals.
Lead test planning and execution for healthcare payer systems, including designing test cases and managing functional, integration, regression, and user acceptance testing. Own defect tracking and resolution, validate EDI transactions and regulatory requirements, coordinate with delivery teams, manage offshore QA analysts, and report execution status and risks.
Provide medication-assisted treatment services to patients through a 100% telehealth program. Join Centurion Health’s team serving the Missouri Department of Corrections.
Assess members with complex or chronic care needs and develop, implement, coordinate, monitor, and adjust care plans to improve health outcomes across the care continuum. Coordinate services and resources, support hospital discharge planning, collaborate with medical directors and providers, and help resolve care, claims, and service issues.
Provide virtual follow-up care to established cardiology patients, assess symptoms and clinical progress, review cardiovascular diagnostic results, and support medication optimization. Coordinate referrals, appointments, patient education, and escalation of care in collaboration with cardiologists and multidisciplinary teams.
Assess members’ health and support needs, develop individualized care plans, and coordinate services and community resources to help members achieve or maintain optimal well-being. Monitor progress toward member goals, address barriers to effective care, and conduct visits in homes and care facilities, with 75–90% local travel.
Supervise utilization management clinical review teams and oversee daily operations, ensuring compliance with applicable guidelines and performance, quality, and efficiency standards. Coach and develop team members, resolve complex member care issues, and collaborate with senior management on policies and process improvements.
Manage assigned clinical trial sites throughout study start-up, conduct, and close-out, ensuring compliance with protocols, ICH/GCP, regulations, and quality standards. Conduct remote and on-site monitoring, maintain study documentation and systems, resolve site performance issues, and support site development, audits, and cross-functional collaboration.
Build scientific relationships with regional and national medical leaders, provide balanced scientific information, and respond to unsolicited scientific questions without sales responsibilities. Support company-sponsored and investigator-sponsored research by advising on study concepts, identifying potential investigators and sites, and assisting with study understanding, enrollment, and retention.
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Review prior authorization cases for commercial and Medicaid members, interpret clinical guidelines, consult with providers and pharmacy staff, and make coverage determinations. Ensure decisions comply with regulatory requirements while managing workload, supporting quality standards, and maintaining productive relationships with internal and external customers.
Conduct utilization management and review for in-home long-term care services, assess medical necessity, and analyze case manager submissions and supporting documentation. Prepare and present cases to the Medical Director, document decisions accurately in ICUE and Community Care, and support colleagues through guidance and coaching.
Conduct intake evaluations and individual therapy, develop and oversee treatment plans, and assess patient progress and level-of-care needs. Coordinate care with outpatient providers and families, collaborate with multidisciplinary teams, manage crises, document in electronic medical records, and provide group therapy as needed.
Assess members’ behavioral health, psychosocial needs, risks, and barriers, and use clinical judgment to connect them with appropriate services. Coordinate care among providers, multidisciplinary teams, and community resources, monitor member progress, and adjust coordination efforts to improve outcomes.
Provide individual social work services to approximately 11 students in grades K–6, following their IEPs and supporting social, emotional, behavioral, and executive functioning goals. Coordinate with teachers, families, IEP teams, and related service providers, and complete consultation, progress notes, documentation, and service logs.
Independently conduct remote and on-site monitoring for multicenter clinical studies, including source verification, regulatory document review, site compliance assessment, issue resolution, and reporting. Manage site operations and study tracking, support investigators and study teams, lead centralized monitoring activities, and train junior CRAs.
Provide telephone triage nursing services to patients in a primary care setting, using clinical judgment and applicable protocols. Communicate with the manager, colleagues, patients, and other contacts while maintaining courteous, cooperative, and culturally respectful working relationships.
Provide telephone triage coverage for primary care patients on an as-needed, per diem basis. Communicate with the manager, colleagues, patients, and other contacts while maintaining courteous, cooperative, and culturally respectful working relationships.
Provides nursing assessments and clinical triage by phone, prioritizes patient needs, and coordinates appointments and access to clinical and supportive services. Supports callers and non-clinical staff, identifies at-risk patients, and collaborates with multidisciplinary teams and physician offices to coordinate care.
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Conduct structured and semi-structured interviews with clinical trial participants with Borderline Personality Disorder, administering, scoring, and documenting validated rating scales. Maintain inter-rater reliability and protocol compliance, escalate safety concerns, and collaborate with investigators, site staff, and sponsor or CRO teams.
The Behavioral Health Case Manager coordinates and manages behavioral health services for Medicare and Commercial members through assessments, care planning, and ongoing monitoring. The role also involves providing 24/7 crisis intervention, risk assessment, and collaborating with interdisciplinary teams to optimize health outcomes.
The Care Manager is responsible for overseeing the quality of care and coordinating holistic care plans for participants within an interdisciplinary team. They also monitor field staff documentation, conduct coaching sessions, and ensure services align with federal and state regulations.
Assess members’ physical and behavioral health needs, develop and monitor care plans, coordinate with providers and multidisciplinary teams, and connect members with psychosocial support services. Provide crisis intervention and follow-up, promote member engagement and informed healthcare decisions, and document care in accordance with regulatory and company requirements.
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