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**Job Description** **Job Summary** The Medical Review Nurse provides support for medical claim and internal appeals review activities - ensuring alignment with applicable state and federal regulatory requirements, Molina policies and procedures, and...

A leading healthcare organization is looking for a Nurse Reviewer I to conduct preauthorization and appropriateness of treatment reviews for diagnostic imaging services. The role supports remote work and requires an associate degree in nursing...

A leading healthcare provider in Winston-Salem is seeking a Telehealth Nurse to provide nursing services remotely. Applicants should have a valid RN license and at least 3 years of clinical experience, preferably in telephone triage. Strong...

Medical Review Nurse The Medical Review Nurse provides support for medical claim and internal appeals review activities - ensuring alignment with applicable state and federal regulatory requirements, Molina policies and procedures, and...

Medical Review Nurse The Medical Review Nurse provides support for medical claim and internal appeals review activities - ensuring alignment with applicable state and federal regulatory requirements, Molina policies and procedures, and...

Performing pre-service clinical coverage review of services (predetermination reviews), using applicable benefit plan documents, evidence-based medical policy and nationally recognized clinical guidelines and criteria. Managing clinical Out of...

Medical Review Nurse The Medical Review Nurse provides support for medical claim and internal appeals review activities ensuring alignment with applicable state and federal regulatory requirements, Molina policies and procedures, and...

A healthcare service provider is seeking a Registered Nurse - Case Review Specialist to provide remote support in reviewing cases for Federal Occupational Health. The ideal candidate will have at least 5 years of Nursing experience, a valid RN...

We believe everyone should have confidence in navigating their healthcare. We are looking for a qualified Registered Nurse (RN) to serve our patient population in the navigation, prevention and management of their health through continuous care...

Medical Review Nurse The Medical Review Nurse provides support for medical claim and internal appeals review activities ensuring alignment with applicable state and federal regulatory requirements, Molina policies and procedures, and...

A state government agency in Florida is seeking a Registered Nurse Specialist to support foster children with complex medical needs. The role involves conducting assessments, home visits, and collaborating with caregivers and healthcare teams.

Clinical Claims Review At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better.

Medical Review Nurse The Medical Review Nurse provides support for medical claim and internal appeals review activities ensuring alignment with applicable state and federal regulatory requirements, Molina policies and procedures, and...

Provide support to all units within Claims to ensure all clinical components are met for CMS, NCQA, URAC, DOL, DOI, and all other State and Federal entities. Identify business priorities and necessary processes to triage and deliver work. Use...

Overview Contract role - 8/8/23-12/31/23, with possible extension Pay rate: $50-$65 Hourly Location: Remote IL Required License: RN, LCSW, LCPC Basic function: This position is responsible for discharge care...

Medical Review Nurse The Medical Review Nurse provides support for medical claim and internal appeals review activities ensuring alignment with applicable state and federal regulatory requirements, Molina policies and procedures, and...

Registered Nurse (RN) Outpatient Clinic- Float Team - Hybrid/Partially Remote The RN is responsible for providing clinical support to providers and patients in Clinical Practice Group (CPG) office. These duties may include: patient care,...

A leading healthcare company is seeking a Tele-Health Nurse to provide support to patients and caregivers through telephonic interactions. This remote position requires a Registered Nurse licensure and is ideal for those with a passion for...

Remote position, however, candidates must reside in the State of TX or State of IL. This position is a contract for about 9 months. Pay: $41/hour Job Responsibilities: RN working in the insurance or managed...

A leading home health care provider is seeking a Compliance RN Home Health Clinical Partner in Nashville, TN. This full-time position involves conducting clinical audits, performing HIPAA checks, and providing compliance education. Ideal...

A talent marketplace for AI research is seeking experienced Registered Nurses to work remotely on innovative projects. You will create and review deliverables that contribute to advancing AI research. Ideal candidates should have over 4 years of...

A leading health company is seeking a Telephonic Nurse Case Manager II responsible for managing care for members with chronic needs. The position requires a BA/BS in a health-related field, a current RN license, and five years of clinical...

A nationwide home infusion company is seeking a Quality Assurance Chart Review Nurse. This role involves reviewing clinical records for compliance and accuracy. Candidates should have a nursing degree, an active license, and experience in home...

Medical Review Nurse The Medical Review Nurse provides support for medical claim and internal appeals review activities ensuring alignment with applicable state and federal regulatory requirements, Molina policies and procedures, and...

ResPro Health is dedicated to providing our partners in the respiratory space with the tools and resources needed to implement meaningful programs like remote patient monitoring and chronic care management in their pulmonary practices. With a...