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Responsibilities SafeGuard Services (SGS), a subsidiary of Peraton, performs data analysis, investigation, and medical review to detect, prevent, deter, reduce, and make referrals to recover fraud, waste, and abuse.

*Job Summary and Responsibilities* As our surgical services nurse at Glendale Memorial Medical Center you will prepare patients for surgical procedures and assist in the operating room to ensure they receive excellent nursing when they are at...

Provides direct nursing care including assessment, plan of care, education, and evaluation for assigned patients. Performs patient duties necessary to maintain the flow of patient care as well as coordinates the delivery of care...

Position Purpose: Performs concurrent reviews, including determining member's overall health, reviewing the type of care being delivered, evaluating medical necessity, and contributing to discharge planning according to care policies and...

Prime Staffing is seeking a travel nurse RN Clinic for a travel nursing job in Tarzana, California. Job Description & RequirementsSpecialty: ClinicDiscipline:...

Description RN - Quality Assurance located at Providence Willamette Falls Medical Center (primary location) and Providence Milwaukie Hospital (secondary location), with rare travel to Providence Newberg Medical Center. The position does not...

We're building a world of health around every individual - shaping a more connected, convenient and compassionate health experience. At CVS Health®, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold...

University Hospitals is seeking a Registered Nurse to collaborate with the health care team to coordinate admissions, continued stays, and level-of-care decisions. You will communicate with patients and families to ensure timely care and proper...

Current Employees: If you are a current Staff, Faculty or Temporary employee at the University of Miami, please click here to log in to Workday to use the internal application process. To learn how to apply for a faculty or staff...

Lee Health is hiring for a Utilization Management RN position. This remote role begins onsite for the first 90 days and requires licensure in Florida. The nurse will perform utilization management duties, ensure regulatory compliance, and document...

Overview TEEMA is partnering with a leading organization supporting a large-scale federal healthcare program to identify a Clinical Quality Reviewer. This role focuses on reviewing clinical cases, identifying potential quality or safety...

Clinical Documentation Improvement Specialist-RN- Remote The Clinical Documentation Improvement (CDI) Specialist Registered Nurse (RN) assists with the identification of diagnoses, conditions, and procedures that are representative of the...

Mass General Brigham Health Plan UM Nurse Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a...

Cardinal Health is seeking a Virtual Injection Training Nurse within Individualized Care. The role educates patients on therapies, conducts virtual injection training via Zoom with patients and caregivers, and collaborates with healthcare...

JOB DESCRIPTION Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and...

Molina Healthcare is seeking an Illinois-licensed RN Case Manager to support Medicare members in Illinois. This telephonic role may require occasional face-to-face meetings from home, with 8 AM–5 PM CST hours. Preference given to applicants with...

Supports the values of service excellence, teamwork, and integrity while managing patient care. Acts as a liaison among patients, caregivers, multidisciplinary teams, and payers. Qualifications: Requires a...

Service Coordination Manager, RN Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting...

LVN Locations: Los Angeles, California Job Category: Nursing Support Position Type: Full-Time Shift: Days Job Description Join a team that's shaping the future of...

We're building a world of health around every individual - shaping a more connected, convenient and compassionate health experience. At CVS Health®, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold...

Agency Adult Correction Division COO - Health Services Job Classification Title Registered Nurse (S) Position Number 60070607 Grade MH15 About Us...

The Ohio State University is seeking a Staff Nurse (RN) for Oncology Continuing Care Triage. This remote phone triage role handles oncology patient calls, performs initial assessments, and uses triage algorithms to guide care. The nurse documents...

Long Term Care RN Elk Horn, IA $1539 /Weekly Gross**Estimated pay package. Does not include taxes, insurance, or other deductions that may occur 12H Nights 13 Weeks 36 Skilled Nursing Facility...

nirvanaHealth, a RxAdvance Corp. company, seeks a part-time Utilization Management Nurse for a remote role in the United States. You will perform prospective, concurrent, and retrospective medical necessity reviews and care coordination to ensure...

Job Description & Requirements Hospitalist Nurse Practitioner (NP) StartDate: ASAP Available Shifts: Day 8 Pay Rate: $104.76 - $113.40 This facility is seeking a Hospitalist Nurse Practitioner (NP) for locum tenens support as...