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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...

*Job Summary and Responsibilities* As our Registered Nurse (RN), you will be a pivotal healthcare professional, delivering compassionate, high-quality care that truly impacts our patients' well-being and recovery. Every day, you will...

Humana is seeking a Pre-Authorization Nurse for remote work to review prior authorization requests and determine appropriate care following guidelines. The role involves clinical judgment, data entry in management systems, and collaboration 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 current RN license, nursing diploma or...

*Job Summary and Responsibilities* As our Registered Nurse (RN), you will be a pivotal health care professional, delivering compassionate, high-quality care that truly impacts our patients' well-being and recovery. Every day, you will...

Dialysis experience required Western Regional Float, MULTI-STATE travel required PURPOSE AND SCOPE: The professional...

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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...

Saint Joseph Health System is seeking an RN Utilization Review specialist for a part-time, remote PRN role that requires on-site training in Mishawaka, Indiana. The position emphasizes reviewing medical necessity, insurance requirements, and...

Humana is seeking a Pre-Authorization Nurse to review requests for medical necessity and level of care, working remotely from Virginia or a compact-licensed state. You will educate providers, document clinical data, and make independent...

*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...

CVS Health Corporation is seeking a RN-qualified professional to lead quality improvement initiatives and performance measurement within POSC, aiming to meet HEDIS and CAHPS goals. The role involves analyzing clinical workflows, implementing...

Utilization Management Registered Nurse (RN) - Remote Full-time WHO IS GUIDEHEALTH? Guidehealthis a data-powered, performance-driven healthcare company dedicated to operational excellence. Our goal is to make...

Remote Registered Nurse – Clinical Review Fully Remote | $48–$65/hr | Monday–Friday, 9:00 AM–6:00 PM ET Medix is supporting a healthcare technology organization that is adding...

Responsibilities: How you'll change lives ...

As a Clinical Documentation Review Specialist (RN), you will help medical staff clarify patient records to ensure appropriate reimbursement and reflect care complexity. You will perform concurrent reviews and engage with physicians...

Case Manager Utilization RN, 32 Day Job Summary: Works collaboratively with an MD to coordinate and screen for the appropriateness of admissions and Continued stays. Makes recommendations to the physicians for alternate...

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...

BJC HealthCare in Missouri is seeking an experienced RN for a remote Utilization Review role supporting hospital units nationwide. The position requires patient-care experience in hospitalized settings and UR background, with no patient...

Sagility is hiring an RN Utilization Management Reviewer for a fully remote, home-based role in the United States. You will perform day-to-day clinical and service authorization reviews for medical necessity and ensure compliance with CMS...

JOB DESCRIPTION - REGISTERED NURSE (A) Job Summary: The Registered Nurse provides patient care on a supplemental basis to our client facilities. With the delivery of safe, quality patient care as...

JOB DESCRIPTION Job Summary Work Location: California - Ability to work remote, but selected candidate must reside in the state of California. This position requires California RN Licensure. Candidates must...

Qlarant, a nonprofit organization, seeks a Nurse Specialist II to perform medical record and claims review for Medicare, Medicaid, and other data. This remote role in the United States involves ensuring adherence to guidelines while assessing for...

Bon Secours Mercy Health is seeking an RN Infection Prevention professional to manage system-wide IPC activities, ensuring compliance with regulatory standards. This role supports outbreak investigation, surveillance, and performance improvement...