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Job Title: Remote Prior Authorization Registered NurseJob Description We are seeking experienced Registered Nurses (RNs) to join a remote Prior Authorization team supporting Dual Eligible (Medicare and Medicaid) populations. In...

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...

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,...

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...

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data...

JOB DESCRIPTION Must reside in Florida Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and align with established...

To support an upcoming clinical project, experienced Registered Nurses (RNs) will find a fully remote contract opportunity as a Remote RN Clinical Consultant, focusing on conducting comprehensive medical record and clinical chart reviews while...

Get AI-powered advice on this job and more exclusive features. This range is provided by Medix. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more. Base pay range $37.00/hr...

Home Health Clinical Referral NurseOrganization: SCAH-Sutter Care at Home - UTPosition Overview: The Home Health Clinical Referral Nurse serves as the initial point of contact for potential home health patients, working closely with our clerical...

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data...

WHO IS GUIDEHEALTH? Guidehealth is a data-powered, performance-driven healthcare company dedicated to operational excellence. Our goal is to make great healthcare affordable, improve the health of patients, and restore the fulfillment of...

Get AI-powered advice on this job and more exclusive features. This range is provided by The Judge Group. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more. Base pay range...

Healthcare Management Solutions, LLC is seeking experienced CHSD Audit reviewers to conduct independent medical record reviews for the STS CHSD program. This remote, part-time role focuses on data accuracy, source verification, and adherence to...

Centene Corp. is hiring a Quality Improvement Coordinator II to conduct reviews of delegated entities for quality, service performance and utilization, and to lead clinical quality initiatives across provider sites. The role involves...

VA Greater Los Angeles Healthcare (VAGLAHS) seeks two RN professionals for Remote Patient Monitoring - Home Telehealth. You will oversee the nursing process, care coordination, patient education, and health promotion, collaborating with the...

CVS Health is seeking a remote Appeals Nurse Consultant to review and resolve clinical appeals with sound clinical judgment and regulatory knowledge. The role supports a remote team with standard Monday–Friday hours and occasional on-call.

Washington State Department of Social and Health Services is seeking a registered nurse with long-term care experience to join our Nursing Consultant team. This role focuses on inspections, investigations, and applying state nursing requirements...

Exceptional care starts with exceptional people. For us, this is more than a job– it's a calling. It's waking up each day, looking for ways to make a difference with a compassionate, inclusive and talented team. Ochsner empowers you...

Optum Infusion Pharmacy is seeking a Clinical Administrative Consultant RN (CAC, Clinical Coordinator) to act as a clinical liaison and coordinate home or AIS infusion therapy for patients across the U.S. The role supports initial intake,...

Oscar Health is seeking a Utilization Review Nurse to join our team. You will review cases, verify medical records, and consult with care providers to assess treatment appropriateness using Oscar Clinical Guidelines, MCG, and InterQual. The...

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...

Guidehealth is seeking a Registered Nurse (RN) for a remote Telehealth Medicare Annual Wellness Visit Specialist - PRN. The role conducts AWVs via telehealth under physician supervision, focusing on preventive care and patient education.

Type: Clinic Somerville , MA SkyBridge Healthcare is currently seeking Registered Nurse with Clinic experience for a 13-week contract in MA. SkyBridge Healthcare is a premier staffing firm dedicated to matching outstanding talent...

Connect America is seeking a Remote Care Nurse II to deliver high-quality nursing care to patients in a remote setting via telehealth. You will perform remote assessments, develop care plans, and coordinate with a multidisciplinary team to improve...

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...