This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description As the Utilization Management (UM) Physician Reviewer, you will report to the Medical Director of UM and provide clinical expertise to ensure high-quality, medically necessary, and efficient patient care aligned with regulatory requirements. This role involves making direct decisions in prior authorization, concurrent review of hospitalized patients, and discharge planning. - Clinical review of prior authorization, concurrent review, and retrospective review requests using critical thinking and established guidelines. - Interpreting benefit language and ensuring accurate documentation. - Engaging in peer-to-peer discussions with providers and collaborating with other healthcare professionals. - Handling appeals and grievances while ensuring compliance with federal, state, and accreditation standards. - Acting as a clinical liaison and participating in case reviews and fair hearing processes. - Identifying utilization trends and contributing to policy development and quality improvement. - Guiding UM nurses and clinical staff while staying current with evidence-based medical literature and healthcare trends. This position is remote, but will be expected to work PST business hours. This position is part-time, working approximately 20 hours/week, with flexible days/hours. The schedule includes weekend and holiday rotations ensuring coverage for urgent reviews. Qualifications - Clear and current California MD or DO license. - Proficiency in using electronic health records and UM software platforms (after training). Requirements - 2+ years of experience in a direct patient care setting, Primary care specialty preferred. - Experience in utilization management, medical review, or managed care setting preferred. - Strong knowledge of clinical standards of care, NCQA requirements, CMS guidelines, and Medicaid / Medicare programs and dual eligible populations, and benefit systems preferred. Benefits - Competitive pay with a flexible Health & Welfare benefits package. - Cafeteria-style benefit program allowing employees to choose benefits from various options, including medical, dental, and vision plans for employees and their dependents. - Health Spending Account (HSA), Life Insurance, and Long Term Disability. - 401k retirement plan with a generous employer-match. - Paid Time Off and Sick Leave.

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description The Registered Nurse (RN) plays a critical role as a physician extender within a remote healthcare team. In this position, the RN supports providers by efficiently managing Electronic Health Records (EHR), responding to patient inquiries, and delivering timely clinical guidance to promote high-quality patient care. - Respond to calls for a multi-state nurse triage telephone service, managing inbound and outbound patient communications. - Assess and triage patient needs, conducting follow-up outreach. - Facilitate effective communication between patients and healthcare professionals. - Contribute directly to improved patient outcomes and overall team effectiveness. Qualifications - Associate’s or Bachelor’s Degree in Nursing. - Minimum of 2–4 years of full-time clinical experience as a Registered Nurse, preferably in areas such as Emergency Room/Urgent Care, Adult or Pediatric Care, OB/GYN, Orthopedics, Ambulatory Care, Home Health, or ICU. - Prior telephone triage experience using electronic triage systems and experience with at least two different Electronic Health Record (EHR) platforms. - Active, unencumbered Enhanced Nurse Licensure Compact (eNLC) license required. Additional non-compact state licensure is considered an asset. - Willingness to obtain additional state licenses as requested by the company. Requirements - Proven ability to collaborate effectively with peers, cross-functional teams, and leadership. - Willingness to step into leadership when needed, motivate colleagues, and share knowledge to enhance team performance. - Strong empathy, patience, and active listening skills to effectively address patient needs. - Excellent attention to detail in documentation, including correct grammar, spelling, and medical terminology. - Highly organized, with the ability to manage and accurately document a minimum of four calls per hour during peak times. Physical Requirements - Ability to sit for extended periods while speaking and actively listening without visual contact with patients. - Occasional standing and use of hands for operating office equipment; infrequent stooping, kneeling, or crouching. - Ability to hear within normal range and comfortably wear a headset or earpiece. - Adequate visual acuity to read computer screens, scripts, and forms. - Ability to work remotely from a private, HIPAA-compliant home workspace. - Ability to house company-provided equipment necessary for job performance. - Reliable broadband internet access. - Ability to participate in staff meetings via telephone or video. Work Environment - Ability to thrive in a fast-paced, remote environment. - Demonstrated capability to maintain professional relationships with diverse personalities. - Flexibility and adaptability to change, with effective stress-management skills. - May require occasional overtime or adjusted start times based on operational needs.

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description The Registered Nurse (RN) plays a critical role as a physician extender within a remote healthcare team. In this position, the RN supports providers by efficiently managing Electronic Health Records (EHR), responding to patient inquiries, and delivering timely clinical guidance to promote high-quality patient care. - Respond to calls for a multi-state nurse triage telephone service. - Manage inbound and outbound patient communications. - Assess and triage patient needs. - Conduct follow-up outreach. - Facilitate effective communication between patients and healthcare professionals. - Contribute directly to improved patient outcomes and overall team effectiveness. Qualifications - Associate’s or Bachelor’s Degree in Nursing. - Minimum of 2–4 years of full-time clinical experience as a Registered Nurse, preferably in areas such as Emergency Room/Urgent Care, Adult or Pediatric Care, OB/GYN, Orthopedics, Ambulatory Care, Home Health, or ICU. - Prior telephone triage experience using electronic triage systems and experience with at least two different Electronic Health Record (EHR) platforms. - Active, unencumbered Enhanced Nurse Licensure Compact (eNLC) license required. - Additional non-compact state licensure is considered an asset. - Willingness to obtain additional state licenses as requested by the company. Requirements - Proven ability to collaborate effectively with peers, cross-functional teams, and leadership. - Willingness to step into leadership when needed, motivate colleagues, and share knowledge to enhance team performance. - Strong empathy, patience, and active listening skills to effectively address patient needs. - Excellent attention to detail in documentation, including correct grammar, spelling, and medical terminology. - Highly organized, with the ability to manage and accurately document a minimum of four calls per hour during peak times. Physical Requirements - Ability to sit for extended periods while speaking and actively listening without visual contact with patients. - Occasional standing and use of hands for operating office equipment; infrequent stooping, kneeling, or crouching. - Ability to hear within normal range and comfortably wear a headset or earpiece. - Adequate visual acuity to read computer screens, scripts, and forms. - Ability to work remotely from a private, HIPAA-compliant home workspace. - Ability to house company-provided equipment necessary for job performance. - Reliable broadband internet access. - Ability to participate in staff meetings via telephone or video. Work Environment - Ability to thrive in a fast-paced, remote environment. - Demonstrated capability to maintain professional relationships with diverse personalities. - Flexibility and adaptability to change, with effective stress-management skills. - May require occasional overtime or adjusted start times based on operational needs.

Role Description This is an entry level position responsible for processing all release of information (ROI), specifically medical record requests, in a timely and efficient manner ensuring accuracy and providing customers with the highest quality product and customer service. Associate must at all times safeguard and protect the patient’s right to privacy by ensuring that only authorized individuals have access to the patient’s medical information and that all releases of information are in compliance with the request, authorization, company policy and HIPAA regulations. - Full-Time: Monday - Friday, 8:00 am - 4:30 pm EST - Location: Remote - Comfortable working in a high-volume production environment. - Processing medical record requests by taking calls from patients, insurance companies and attorneys to provide medical record status. - Documenting information in multiple platforms using two computer monitors. - Proficient in Microsoft Office (including Word and Excel). Qualifications - High School Diploma or GED. - Ability to commute between locations as needed. - Able to work overtime during peak seasons when required. - Basic computer proficiency. - Comfortable utilizing phones, fax machine, printers, and other general office equipment on a regular basis. - Professional verbal and written communication skills in the English language. - Detail and quality oriented as it relates to accurate and compliant information for medical records. - Strong data entry skills. - Must be able to work with minimum supervision responding to changing priorities and role needs. - Ability to organize and manage multiple tasks. - Able to respond to requests in a fast-paced environment. Requirements - Receive and process requests for patient health information in accordance with Company and Facility policies and procedures. - Maintain confidentiality and security with all privileged information. - Maintain working knowledge of Company and facility software. - Adhere to the Company's and Customer facilities Code of Conduct and policies. - Inform manager of work, site difficulties, and/or fluctuating volumes. - Assist with additional work duties or responsibilities as evident or required. - Consistent application of medical privacy regulations to guard against unauthorized disclosure. - Responsible for managing patient health records. - Responsible for safeguarding patient records and ensuring compliance with HIPAA standards. - Prepares new patient charts, gathering documents and information from paper sources and/or electronic health record. - Ensures medical records are assembled in standard order and are accurate and complete. - Creates digital images of paperwork to be stored in the electronic medical record. - Responds to requests for patient records, both within the facility and by external sources, retrieving them and transmitting them appropriately. - Answering of inbound/outbound calls. - May assist with patient walk-ins. - May assist with administrative duties such as handling faxes, opening mail, and data entry. - Must meet productivity expectations as outlined at specific site. - May schedule pick-ups. - Other duties as assigned. Benefits - Comprehensive onsite/virtual training program followed by job shadowing with an assigned mentor. - Company equipment will be provided to you (including computer, monitor, virtual phone, etc.). - Full Benefits: PTO, Health, Vision, and Dental Insurance and 401k Savings Plan and Tuition Assistance.