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The Registered Nurse provides expert professional nursing care; assesses, plans, implements and evaluates the care rendered to patients with urgent, emergent or potential health problems; utilizes knowledge of basic nursing principles,...

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...

After Hours Service Answer Line Rn The Answer Line After Hours Service provides after-hours exchange and nurse triage services for over 300 subscribing community pediatricians in the St. Louis and surrounding areas. Answer Line RNs...

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...

Optum is seeking a Fertility Utilization Management RN to work remotely within the United States. You will assess and determine the appropriateness of inpatient and outpatient services, translating clinical concepts into practical care-management...

Molina Healthcare is seeking a Wisconsin-licensed RN for a remote IRIS Self-Directed Personal Care (SDPC) role. You will oversee a group of IRIS participants, assess needs, and educate providers and participants in their homes and communities.

Job Description Description: Work Schedule: Day/evening, you will work six 10-hour shifts per pay period including weekend rotation. Holiday rotation required. Hours are based off...

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...

*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...

The Licensed Vocational Nurse is responsible for providing direct or indirect nursing care to patients who present with urgent, emergent, or potential health problems;...

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,...

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...

Trillium Health Resources is seeking a Registered Nurse to join our Utilization Management team in North Carolina. The UM reviews, coordinates care, and supports discharge planning to improve outcomes and ensure appropriate utilization of...

JOB DESCRIPTION Opportunity in Southern California for an experienced Managed Care Leader to join our health plan in California. Candidates must have a minimum of 7 years of healthcare experience, 3 of those should be with a Managed Care...

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...

*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...

Location: Orion Building - 6630 Orion Drive Fort Myers FL 33912 Department: Utilization Management - Corporate Work Type: Full Time Shift: Shift 1/7:00:00 AM to 3:30:00 PM Minimum to...

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...

Job Description & Requirements Family Medicine Nurse Practitioner or Physician Assistant(NP) StartDate: ASAP Available Shifts: Day 8 Pay Rate: $72.75 - $78.75 This facility is seeking a Family Medicine Nurse Practitioner or...

Abbott is seeking a per-diem RN trainer in the Durham, NC area to deliver Face-2-Face training for home testing customers. You will guide finger stick collection, explain PT/INR device use, and assist with reporting responsibilities. The...

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...

UnitedHealth Group is seeking a Patient Care Coordinator to support the National Start of Care Nursing Team. The role involves nursing coordination for infusion services, managing referrals, intake and patient management, and coordinating with...

Trinity Health is seeking a Night Shift RN Utilization Review in Grand Rapids, MI, offering full-time work with remote options. You will review assigned cases against criteria and payor guidelines to ensure proper reimbursement and medical...

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...

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...