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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...

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

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...

Job Summary This position is responsible for ensuring compliance with Utilization Management (UM) and Quality Review (QR) functions performed by the health plan. The role supports clinical review activities requiring 5+ years of...

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...

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.

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...

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...

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...

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...

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...

Ethos Risk Services is seeking a full-time Clinical Recruiter (REMOTE) to lead hiring for the Case Management division. You will own full-cycle recruiting for nurse case managers and other clinical pros, from posting to onboarding, ensuring a...

Job Title: Clinical Quality Assurance Nurse Pay: see below Registered Nurse - $28.50/hr (Non-negotiable) LPN/LVN- $26.50/hr (non-negotiable) Regular Schedule after training: M-F...

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

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...

Bring clinical insight, nursing expertise, and data-driven precision to a Hybrid/Remote Clinical Documentation Improvement Nurse Specialist career that combines meaningful patient impact, supportive leadership, modern healthcare technology,...

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...

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,...

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...

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...

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...

HonorHealth is seeking an experienced Utilization Review RN Specialist for a remote-capable role serving the greater Phoenix area. The position focuses on reviewing medical necessity and coordinating reviews for diverse payers, ensuring...

Centene Corporation in the United States is seeking a Nursing professional to analyze prior authorization requests and determine medical necessity and level of care in line with standards and coverage. You will collaborate with medical teams to...

Southcoast Health seeks a Team Lead-Centralized Clinic Support to join a remote role serving MA/RI communities. The role guides nursing staff, ensures clinical workflow compliance, and drives care coordination and patient safety across ambulatory...