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

*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...

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.

Position Purpose: Analyzes all prior authorization requests to determine medical necessity of service and appropriate level of care in accordance with national standards, contractual requirements, and a member's benefit coverage. Provides...

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,...

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...

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...

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...

Research Nurse (Per Diem) - Greater Portland, OR Area Illingworth Research Group provides a range of patient focused clinical services to the pharmaceutical, healthcare, biotechnology and medical device industries. These include mobile...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

Trillium Health Resources is seeking a Population Health Nurse to provide clinical care management and population health support for assigned members, focusing on prevention, wellness, and outcomes. The role uses nursing judgment as an RN to...

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...

Army Public Health Nurse Job Overview As an Army Public Health Nurse, you'll assess health risks and implement programs to monitor the spread of disease. You'll promote wellness for Soldiers and their families while also informing policy and...