Join a dynamic team dedicated to transforming health care delivery across the United States. We are creating innovative solutions that integrate physical, mental, and social care needs, ensuring patients can access and navigate care seamlessly from hospital to home.
As a member of our care transition team, you'll play a crucial role in supporting older adults as they move through different care settings, ultimately giving them more time to spend at home. We're committed to connecting care across settings to create a smooth health journey for every patient.
Why join us?
At our organization, we're driven by a mission to collaborate with exceptionally talented individuals who are passionate about making a positive impact on society through health care transformation. With nearly two decades of innovation, we challenge the conventional norms of care transitions, focusing on changing health care for the better, one patient at a time. We offer a stimulating environment where you can grow professionally, leveraging the latest technologies in line with our strategic vision.
This position offers the flexibility to work remotely from anywhere within the U.S., with a preference for daytime availability in Central and Eastern Time Zones, though Mountain and Pacific Time Zones are also considered.
Primary Responsibilities
Provide daily oversight of utilization and communicate externally with network physicians and hospitals.
Conduct daily utilization management (UM) reviews, including authorizations and denial reviews.
Facilitate peer-to-peer clinical case reviews as needed.
Engage in telephonic reviews and discussions with providers, sharing tools, information, and guidelines for cost-effective health care delivery and quality.
Communicate effectively with network and non-network providers to ensure efficient administration of our services.
Serve as a non-promotional medical contact point for various health care providers, responding to clinical inquiries.
Represent our organization externally, establishing and maintaining relationships with thought leaders.
Collaborate closely with Client Services Team to coordinate delivery system providers.
Contribute to action plans and strategic initiatives, addressing concerns and monitoring progress.
Interact and collaborate with network physicians, hospital leaders, and vendors on care and services.
Provide leadership in maximizing cost management through effective network and provider contracting.
Participate in naviHealth's Medical Advisory Board.
Provide intermittent weekend and evening coverage as scheduled.
Required Qualifications
Perform additional duties as required or assigned.
Board certification as an MD, DO, or MBBS with a current, unrestricted license to practice and maintain necessary credentials.
Ability to obtain licensure in multiple states.
Minimum of 3 years post-residency patient care experience, preferably in inpatient or post-acute settings.
Preferred Qualifications
Licensure in multiple states.
Understanding of population-based medicine, including knowledge of CMS criteria for post-acute care.
Ability to work effectively within a team environment while managing multiple tasks.
Proficiency in electronic health records and related technology.
Strong organizational, analytical, and communication skills.
Ethical integrity and motivation to thrive in a fast-paced, dynamic environment.
Employees working remotely must adhere to our Telecommuter Policy.
Employment Type: Full-Time
Seniority level
Mid-Senior level
Employment type
Full-time
Job function
Health Care Provider
Industries
Human Resources Services
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