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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...

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

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...

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...

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...

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...

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...

Compliance Nurse 2, Long-Term Care Unit The Georgia Department of Community Health (DCH) is one of Georgia's four health agencies serving the state's growing population of over 10 million people. DCH serves as the lead agency for...

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...

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...

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...

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...

A health care organization is seeking a Clinical Documentation Improvement Specialist (RN) to enhance the accuracy and quality of patient documentation. The ideal candidate will have experience in clinical nursing and a strong ability to work with...

Registered Nurse II Locations: Los Angeles, California Job Category: Registered Nurse Position Type: Full-Time Shift: Nights Job Description Join a team that's shaping...

Guidehealth is seeking an Utilization Management Registered Nurse to perform medical-necessity reviews and document findings for determinations. The role involves collaborating with medical leadership, reviewing cases for appropriate treatments,...

Teleperformance is seeking a Healthcare Customer Service Representative to handle inquiries via phone, email, chat, and social media. The role focuses on de-escalation, issue resolution, and proactive payment processing while maintaining quality...

Job Title: Clinical Quality Assurance Nurse Pay: see below Registered Nurse - $28.50/hr (Non-negotiable) LPN/LVN- $26.50/hr (non-negotiable) Regular Schedule after training: M-F 11:30am...

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...

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...

Prolific is seeking Registered Nurses to help train and evaluate AI models. You'll be invited to join Prolific as a Domain Expert participant, where you'll get paid to train and evaluate powerful AI models from home. Researchers pay up to...

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...

Corewell Health is seeking a Telehealth Registered Nurse to provide remote patient care from the Care Center Breton in Kentwood. You will work evenings with 36 hours per week, delivering patient assessments, education, and follow-up via telehealth...

Nurse Navigator - Cancer Center Exams - 10 Hour Days Beverly Hills, CA, United States Job Description Do you have a passion for the highest clinical quality and patient happiness? Would you like to use your expert clinical...