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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 levels of care when the patient does...

We're building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold...

Job Summary: Works collaboratively with an assigned panel of physicians to manage the patients specialized needs. The managing team does differ according to the chronic disease. Duties include assessment to identify member...

CVS Health is seeking an experienced Registered Nurse to coordinate comprehensive patient care, develop personalized plans, and liaise with multiple providers. You will advocate for patients, monitor progress, and optimize resource use to improve...

Guidehealth is seeking a remote-based Care Manager (RN) to guide patients and families through complex health journeys. You will blend clinical expertise with holistic care, addressing medical, behavioral, and social needs while coordinating...

A healthcare organization is seeking an RN Case Manager to work remotely and facilitate case management activities, evaluating medical needs for overall member wellness. Candidates should have an active RN license, ideally compact, with at least...

UnitedHealthcare in Tennessee seeks a Licensed Field Care Coordinator to coordinate care for medically complex members, delivering education, self-management support, and advocacy. This field-based, remote role requires strong clinical skills and...

A healthcare organization is seeking a remote RN to manage patient care related to chronic kidney disease. Responsibilities include ensuring continuity of care, coordinating treatment plans, and documenting patient information. Candidates must...

We're building a world of health around every individual - shaping a more connected, convenient and compassionate health experience. At CVS Health®, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold...

A leading healthcare company is seeking an experienced Telephonic Nurse Case Manager to manage medical claims and facilitate care for injured workers. The ideal candidate will have at least a year of experience in Florida Workers' Compensation,...

UnitedHealthcare is seeking a Care Coordinator (RN) to coordinate care for medically complex members, applying clinical knowledge to case management and ensuring access to Medicare/Medicaid benefits. This field-based role requires collaboration...

ELM Management Services, LLC is seeking an ASC Pre-Admission Testing Registered Nurse (PAT RN) for part-time work in Atlanta, GA, with a remote option. The PAT RN will conduct telephonic pre-op assessments, coordinate clearances, and educate...

A healthcare solutions provider is seeking an experienced Nurse Advocate to work remotely from Kansas. The ideal candidate will possess a nursing license and have at least 3 years of experience. Responsibilities include assisting clients in...

Healthmap Solutions is seeking a Care Navigator to manage kidney health programs and coordinate care across patients, providers, and interdisciplinary teams. You will document in Compass, complete health screenings, med reconciliation, and...

A healthcare services provider is seeking a Remote Utilization Review Nurse to coordinate clinical resources, ensuring compliance with healthcare standards. Responsibilities include processing authorizations, reviewing documentation, and...

Humana Inc. in the United States is seeking a Part C G&A Nurse (Utilization Management Nurse 2) to support case preparation, review medical documentation and coordinate appeal determinations. This remote, full-time role requires an RN with...

University of Miami Health System seeks a full-time Utilization Review Case Manager to work remotely. The role reviews patient charts for prior authorization, concurrent and retrospective utilization, coordinating with the care team for timely and...

Job Summary: Responsible for the oversight and management of skilled patients and temporary skilled patients in rehabilitation in contracted Skilled Nursing facilities; this includes checking benefits, managing up to discharge...

Brighton Health Plan Solutions seeks an experienced Utilization Management Nurse (LPN) to perform medical necessity and benefit reviews remotely. You will work within UM processes, coordinate with partners, and ensure timely, compliant...

Piper Companies is seeking a Remote Utilization Management/Review Nurse to evaluate member cases, ensuring medical necessity and appropriate healthcare service utilization. The role requires clinical expertise and collaboration with providers to...

iMPROve Health seeks an RN Reviewer (Workers' Compensation Utilization Review) to perform independent external medical reviews remotely as an independent contractor (1099). The reviewer applies clinical expertise to evaluate cases, ensuring...

UnitedHealth Group is seeking an Inpatient Utilization Management Nurse, RN for a fully remote role serving the Sacramento area. The position requires 3+ years in acute care and 1+ year in utilization management, with certification in RN licensure...

Guidehealth is seeking a Care Manager to guide patients and families through complex health journeys. This remote role blends clinical expertise with holistic care to address medical, behavioral, and social needs. You will build...

UnitedHealth Group is seeking a Utilization Management Nurse RN to work remotely from anywhere in the U.S. This role involves ensuring efficient health services and requires an active RN license and 3+ years of Managed Care or Clinical experience.

UnitedHealthcare is seeking a field-based Care Coordinator (RN) to coordinate care for medically complex members primarily within Medicare/Medicaid. You will apply clinical knowledge to identify needs, educate members, and ensure access to...