Remoote.app

Work from anywhere. Start here.

JobsFree resume builderCompaniesLog in

thp

At Point32Health, we strive to be a different kind of nonprofit health and well-being company, with a broad range of health plans, and innovative tools that make navigating health and well-being easier, guiding our members at every step of their health care journey to better health outcomes. We are committed to providing high-quality and affordable health care, improving the health and wellness of our members, and creating healthier communities across the country. The Point32Health name is inspired by the 32 points on a compass. It speaks to the critical role we play in guiding and empowering the people we serve to achieve healthier lives. Our employees are hard-working, innovative, and collaborative. They look for opportunities to grow and make a difference, and they help make us strive to be one of the Top Places to work in New England.

Related companies:

🏢 highmark
🏢 Interwell Health
🏢 Precision Medicine Group
👥 1001-5000💰 $35,160,000 almost 4 years agoPharmaceuticalBiotechnologyMedicalPrecision MedicineHealth Care
Website LinkedIn Email Facebook

Jobs at this company:

Apply
🔥 Medical Director, Clinical Reviews
Posted about 14 hours ago

📍 United States of America

🔍 Health and wellbeing

  • Current unrestricted license as a medical or osteopathic doctor.
  • Board-Certified MD or DO in one of the American Board of Medical Specialties.
  • Five years of clinical experience required, preferably in management or utilization management.
  • Skills in utilization management activities in accordance with accreditation standards and guidelines.
  • Ability to communicate effectively with peers and providers.

  • Perform clinical reviews of prospective, concurrent, and retrospective coverage requests for in-patient and out-patient services requiring prior authorization and medical necessity review for all lines of business.
  • Communicate with providers and facilities to resolve clinical issues and concerns.
  • Support the provider inquiry process for peer-to-peer discussions.
  • Perform clinical review of expedited and standard appeals for all lines of business.
  • Participate in quality and credentialing reviews and assist with administrative duties.

Quality Assurance

Posted about 14 hours ago
Apply
Apply
🔥 SCO RN Care Manager - Quincy/Randolph Area
Posted 23 days ago

📍 United States of America

🔍 Healthcare

  • Registered Nurse with a current unrestricted license in state of residence.
  • Bachelor’s Degree in Nursing preferred.
  • 5+ years of relevant clinical experience.
  • Experience in home care or case management preferred.
  • National certification in Case Management desirable.
  • Proficiency in a second language preferred.
  • Experience in specialty areas such as oncology, neurology, or chronic condition management a plus.

  • Administer assessments and develop a care plan in collaboration with members/caregivers and providers.
  • Implement member-specific care management interventions and evaluate the care plan, revising as needed.
  • Provide health education and communication with providers involved in the member's care.
  • Perform outreach to address barriers to wellness, covering medical, behavioral, and psychosocial needs.
  • Coordinate safe transitions to next levels of care post-hospital discharge.
  • Document cases in applicable systems per departmental standards.

Critical thinking

Posted 23 days ago
Apply