• Perform medical claim reviews for one or more of the following: claims for medically complex services, services that require preauthorization/predetermination, requests for appeal or reconsideration, referrals for potential fraud and/or abuse, and correct coding for claims/operations • Make reasonable payment determinations based on clinical medical information and established criteria/protocol sets or clinical guidelines • Determines medical necessity, appropriateness, and/or reasonableness and necessity for coverage and reimbursement • Monitor process’s timeliness in accordance with contractor standards • Document medical rationale to justify payment or denial of services and/or supplies • Educate internal and external staff regarding medical reviews, medical terminology, coverage determinations, coding procedures, etc. in accordance with contractor guidelines • Participate in quality control activities supporting corporate and team-based objectives • Provide guidance, direction, and input as needed to LPN team members • Provide education to non-medical staff through discussions, team meetings, classroom participation, and feedback • Assist with special projects and specialty duties and responsibilities as assigned by management

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description We're looking for an experienced Registered Nurse (RN) to work as a Clinical Nurse, supporting our mobile care teams and delivering high-quality virtual clinical support. - Provide real-time clinical support to mobile care teams, addressing questions and clinical concerns as they arise - Triage patients escalated by in-home teams and deliver education and guidance for higher-acuity or follow-up care needs - Assess and manage escalations involving medical or social risk factors, ensuring timely coordination with the care team and appropriate external resources when needed - Collaborate closely with interdisciplinary team members to ensure coordinated, goal-directed care - Apply strong clinical judgment to identify risk factors and escalate concerns appropriately - Deliver virtual and telephonic patient education regarding diagnoses, test results, and recommended follow-up care - Accurately document all patient interactions in the EHR and mobile applications - Analyze clinical and operational trends to identify opportunities to improve quality and care outcomes - Perform quality audits of clinical documentation and workflows to ensure accuracy, compliance, and adherence to care standards - Minimal travel (1-2 times per year) Qualifications - Active RN license required (Compact licensure required; CA and/or IL licensure preferred) - Virtual care experience preferred - 2+ years of Registered Nurse experience - Comfortable working with modern technology - Strong communication skills - verbal and written - Strong critical thinking and clinical judgment Benefits This is a contract opportunity scheduled to run through the end of 2026. This is a W2 salaried role with benefits. Company Description At Sprinter Health, our mission is reimagining how people access care by bringing it directly to their homes. - Nearly 30% of patients in the U.S. skip preventive or chronic care simply because they can’t get to a doctor’s office. - Supported more than 2 million patients across 22 states. - Completed 130,000+ in-home visits. - Maintained a 92 NPS. - Backed by investors like a16z, General Catalyst, GV, and Accel.

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description The Nurse Practitioner (NP) will deliver high-quality, patient-centered care within a high-volume, well-established bariatric surgery and medical weight loss program. This is an office-based position, with patient care provided primarily through telehealth visits, allowing for efficient care delivery while maintaining close collaboration with the on-site multidisciplinary team. Key responsibilities include: - Preoperative and postoperative management - Chronic disease optimization - Medical weight loss treatment - Lifestyle counseling Essential Duties & Responsibilities - Virtual Patient Care: - Conduct telehealth visits for bariatric and medical weight loss patients, including initial evaluations, follow-ups, medication management, and lab review. - Provide preoperative optimization and postoperative monitoring through virtual platforms, with in-person visits scheduled only as clinically necessary. - Educate and counsel patients remotely on nutrition, physical activity, and long-term weight maintenance. - Clinical Coordination: - Collaborate daily with surgeons, dietitians, behavioral health providers, and nursing staff via secure messaging, EHR, and virtual case conferences. - Maintain a high standard of timely documentation in the EHR for all telehealth encounters. - Patient Flow & Volume: - Manage a steady, pre-established patient panel generated by the practice’s robust referral network and marketing. - Adapt to a fast-paced workflow, balancing efficiency with thorough, personalized care. - In-Person Duties (Minimal): - Attend on-site meetings, training sessions, or patient visits as requested (estimated <10% of role). - Participate in select community events, seminars, or educational workshops. - Compliance: - Adhere to CMS and state regulatory requirements for telehealth, including patient privacy, documentation, and informed consent. - Stay current with evolving telemedicine best practices and technology platforms. Qualifications - Current, unrestricted Florida APRN license. - Board Certification as a Nurse Practitioner (FNP, AGNP, or ACNP preferred). - DEA registration (or eligibility). - BLS and ACLS certification. - Master’s or Doctoral degree in Nursing from an accredited program. - Minimum 2 years as an NP in bariatrics, surgery, weight management, or telehealth preferred. - Proven ability to thrive in a high-volume, patient-focused environment. - Strong telehealth communication skills with ability to build rapport virtually. - Proficiency with EHR, telemedicine platforms, and secure messaging. - Organized, self-motivated, and adaptable to changing patient needs. - Bilingual in English and Spanish preferred.

Role Description Dane Street wants you to join our dynamic team of expert reviewers! In this role, you will have the opportunity to utilize your medical expertise to conduct thorough reviews of clinical cases. This telework opportunity allows you to customize your schedule as a 1099 independent contractor. - Evaluate medical records - Provide clinical summaries - Engage in peer communications - Answer specific questions posed by clients We are on the lookout for talented professionals in the following areas: - Psychiatry - Addiction Psychiatry - Child & Adolescent Psychiatry - Geriatric Psychiatry - Psychology - Neuropsychology Qualifications - Board Certified - Current, unrestricted California Medical License - CALOCUS Training - 5+ years of clinical practice experience - Attends all required orientation and training - Maintains proper credentialing, state licenses, and any certifications or requirements necessary to perform the job Requirements - Independent consultant role allows for schedule flexibility and predictable work hours - You choose services and case types, dictate volume, and conduct this work based on your scheduled availability - No doctor/patient relationship is established, and no treatment is provided; these are advisory-only opinions Benefits - Streamlined case flow and user-friendly work portal - Facilitated communication and organized medical records - Support for all administrative processes - Extensive case preparation and quality assurance for timely delivery of all determinations/reports - Chronological listing of medical records and treatment guidelines provided in an easy, click-to-view format - Initial training and ongoing point of contact for questions about completing reviews