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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...

The Virtual Nurse, RN at MUSC coordinates and delivers professional clinical, quality, and educational services to patients engaging with MUSC via virtual care. This role reports to leadership within the MUSC Center for Telehealth and aims to...

Ensemble Health Partners is seeking a Virtual Utilization Review Specialist to join our remote team. You will perform medical necessity reviews, manage denials, and coordinate with FCC and care management to optimize patient care while controlling...

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...

Registered Nurse (RN)– Downey,CA Local Pay: $52.65/hour - (W2) Join our team and make a meaningful impact by delivering exceptional care in a professional healthcare...

Molina Healthcare is seeking a Care Review Clinician (RN or LPN) for a remote, full-time position operating 8a-5p Pacific Time, Monday through Friday. You will support clinical member services review processes, verify medical necessity, and ensure...

Fully Remote: Clinical Documentation SpecialistFacilitate the improvement of clinical documentation by collaborating with physicians, nursing staff, and other patient caregivers. Perform concurrent and retrospective reviews of medical records to...

Our client, a mutual benefit corporation and health plan provider, seeks an accomplished Registered Nurse (Utilization Management). *** Candidate must be authorized to work in USA without requiring sponsorship...

The Virtual Nurse, RN at MUSC coordinates and delivers professional clinical, quality, and educational services to patients engaging with MUSC via virtual care. This role reports to leadership within the MUSC Center for Telehealth and aims to...

Baptist Health in Jacksonville, FL, is seeking a Registered Nurse for its Hospital At Home program. You will educate patients and families, advocate for patient needs, and coordinate care across medical and nursing teams in a home-based setting.

GQR Healthcare is seeking a travel nurse Correctional for a travel nursing job in Commerce, California. Job Description & RequirementsSpecialty:...

Northwell Health is seeking a Registered Nurse CDI Auditor to validate acute inpatient coded charts and ensure documentation substantiates diagnostic information. This remote position in New York requires a NY RN license, a BSN, and strong...

Essentia Health Moose Lake Clinic is seeking a licensed registered nurse for the Family Practice team. The role emphasizes primary care, triage, and coordination of care for individuals, families, and communities in outpatient settings.

Sentara Health is hiring a part-time Registered Nurse for a Physician Practice in a remote role. The RN will provide outpatient nursing care, triage, education, and care coordination in a physician practice or ambulatory clinic setting.

Molina Healthcare is seeking a Medical Review Nurse (RN) to review documentation for medical necessity and appropriate levels of care, using clinical knowledge and utilization review expertise. This remote US role offers a full-time schedule.

Ochsner Health, a leading not-for-profit healthcare provider in the Gulf South, seeks an experienced RN for a remote case management role. You will coordinate care by liaising with patients, caregivers, multidisciplinary teams, and payers to...

About the job Mercor connects elite creative and technical talent with leading AI research labs. Headquartered in San Francisco, our investors include Benchmark , General Catalyst , Peter Thiel , Adam D'Angelo , Larry Summers , and Jack Dorsey .

Actalent is seeking a dedicated Medical Device Safety Reviewer to collect, review, assess, and process complaints and reports related to medical device adverse events and device deficiencies in clinical studies. This contract position is fully...

Job Title: Nurse, Clinical Medical Review Location: Columbia, MD (Primarily remote, but hybrid) Duration: 6 Months Contract PURPOSE: We are seeking a qualified RN or LPN with experience supporting HEDIS reporting and abstraction processes in a...

AIS Healthcare is seeking a Home Infusion RN to provide IVIG therapies in patients' homes in the Atlanta, GA area. This full-time role emphasizes high-quality, compassionate care delivered outside hospital walls. You will build one-on-one...

Position Title: Remote Telephonic RN Case Manager Mandatory Requirement: Must hold an Active Compact RN License and/or an Active California (CA) RN License to be considered. Pay Rate: $48.00 – $50.00 per hour...

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...

Centene is seeking an RN with strong appeal review experience to act as liaison for statewide appeals, fair hearings, and review organizations. This fully remote role supports members and providers while ensuring compliance with State and NCQA...

GQR Healthcare is seeking a travel nurse Correctional for a travel nursing job in Downey, California. Job Description & RequirementsSpecialty:...

Trustaff is seeking a travel nurse RN Clinic for a travel nursing job in Los Angeles, California. Job Description & RequirementsSpecialty: ClinicDiscipline:...