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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...

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...

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...

CVS Health is hiring an RN Utilization Management Nurse Consultant (Medicare - Joint Procedures) for remote, full-time work. You will review Medicare precertification data, apply criteria, and coordinate care plans to ensure appropriate treatment...

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 sponsorshipLocation: 100% Remote for California...

Responsibilities: How you'll change lives ...

HonorHealth is seeking an Utilization Review RN Specialist to review and monitor the utilization of health care services, ensuring medical necessity and appropriate levels of care. You will coordinate reviews for Medicare, AHCCCS, self-pay, and...

Secondary Review Nurse At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better.

Medix™ seeks an experienced Utilization Review Nurse Specialist for a fully remote role in the United States. You will evaluate medical necessity, determine level-of-care decisions, and collaborate with physicians, interdisciplinary teams, and...

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.

Centene is seeking a Clinical Review Nurse for a remote role supporting members in Pennsylvania. The candidate will perform concurrent reviews, assess care necessity, and contribute to discharge planning, leveraging case management or utilization...

HealthHelp, a WNS company, seeks a Clinical Review Nurse for a fully remote role in the United States. You will perform prospective reviews for medical necessity on prior authorization requests across multiple specialty programs and refer...

WORK REMOTELY after training! CANDIDATE MUST RESIDE IN THE METROPOLITAN NEW YORK AREA! !! Process all requests for services in accordance with Medicare and NYS Medicaid guidelines as well as departmental criteria and...

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

Prime Staffing is seeking a travel nurse RN Research / Clinical Research for a travel nursing job in Fullerton, California. Job Description & RequirementsSpecialty:...

Sedgwick is seeking a Utilization Review RN for a telecommuter role in Michigan. You will review treatment plans, analyze medical records, and determine appropriate care using evidence-based criteria within a collaborative environment.

To support Oregon Medicaid, the full-time Oregon Licensed Utilization Review Clinician will conduct clinical reviews and assessments related to mental health and substance abuse services, ensuring medical appropriateness for both inpatient and...

Float Health is hiring a Recurring Care Specialist for a fully remote US-based role. You will coordinate nursing visits, interface with pharmacies, nurses, and patients, and manage scheduling and communications across platforms. The role...

Valeris is hiring a Patient Support Nurse to engage program patients from enrollment through treatment, helping them initiate and complete therapy successfully. The role requires active RN licensure, 2–3 years of nursing experience, and...

Medical Review Nurse (RN)Remote position, however candidates must reside in the State of TX or State of ILThis position is a contract for about 9 months.Pay: $41/hourRN working in the insurance or managed care industry using medically accepted...

Float Health is seeking an Intake Specialist to manage new patient referrals and coordinate start-of-care visits. This externally facing role requires quick action, clear communication, and meticulous attention to detail to ensure timely,...

Baptist in Meridian, MS seeks a Specialist-Clinical Documentation III RN to evaluate day-to-day documentation practices and advise the clinical team on accurate diagnoses and coding. The role requires five years of acute care experience,...

Clinical Review Nurse - Prior Authorization Various, NV Clinical Review Nurse - Prior Authorization Various, NV All On-site Location: Fully Remote – Prefer Candidates reside in NV, but can reside elsewhere if they...

Explore opportunities with Amedisys, part of the Optum family of businesses. We provide home health, hospice and community-based services that help people receive quality care where they feel most comfortable: at home. Rooted in personalized care,...