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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...

Elevance Health in Denver, CO seeks a Wellness Nurse Consultant to develop and manage health programs for federal employees under the Federal Employee Program. The role is field-based with travel to client sites and occasional home-office work,...

Leading cross-functional initiatives, the full-time RN Medical Coding Consultant will research and develop clinical services, manage episodic projects, and support the implementation of medical policies and coding practices while working...

Hines & Associates is seeking Nurses for a Monday–Friday role, 9:30 AM to 6:00 PM, with no nights, weekends, or holidays. The position emphasizes clinical reviews to determine if treatments meet criteria, with collaboration among case managers...

A Licensed Vocational Nurse, who under the supervision of the Clinical Director, coordinates the functions of the clinical services as it relates to efficient intake of...

MaziCTools is seeking a Freelance Utilization Management Nurse Consultant to work remotely in the United States. This full-time role requires an active RN licensure and 3+ years of clinical experience. Responsibilities include assessing healthcare...

CVS Health is seeking an experienced Utilization Management Nurse Consultant for a 100% work-from-home, full-time position open to MST/PST residents. You will coordinate and document utilization and benefit management activities, ensuring timely,...

Trillium Health Resources is seeking a Compliance Nurse to perform clinical compliance reviews and evaluate claims to ensure adherence to regulatory and coverage requirements. The role requires RN licensure in NC, travel within catchment,...

Responsibilities: How you'll change lives...

A healthcare technology company seeks an experienced Registered Nurse for a remote role providing clinical technology services. This position is for independent contractors, focusing on chart reviews and clinical data analysis. Candidates should...

Alliance Health in North Carolina is seeking a Telework-enabled Care Management Consultant who will provide secondary care coordination and medication reviews for members with physical health needs. The role requires licensure in NC (RN or OT/PT)...

JOB DESCRIPTION Candidates must hold a current California license, 2-3 years case management exprience reside in the San Diego, California area, and be able to...

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Job Description Make a difference every single day! When the work you do every...

MaziCTools is seeking a Freelance Utilization Management Nurse Consultant to work remotely in the United States. This full-time role requires an active RN licensure and 3+ years of clinical experience. Responsibilities include assessing healthcare...

Registered Nurse Navigator - Cancer Center Exams - 10 Hour Days Do you have a passion for the highest clinical quality and patient happiness? Would you like to use your expert clinical competencies with an organization known nationally...

Nursing Assistant PositionUnder the direction of a Registered or Licensed Vocational Nurse, provides basic nursing care and implements selected aspects of the patients nursing plan of care.This position requires providing care/service to an...

Santa Barbara Cottage Hospital is seeking a licensed practical nurse to join BHPS Utilization Management as a remote reviewer of medical necessity and benefit determinations. You will assess cases using clinical guidelines and coordinate with...

Job Title: Contingent Clinical Care LVN/LPN PT - MC Address: Burbank, CA Job Description Administer oral, injectable, intravenous, and topical medications. Evaluate complex patient conditions and document treatment responses. Perform routine...

A quality improvement consulting company is seeking an RN Health Care Facility Surveyor to work remotely with up to 75% travel. Responsibilities include conducting surveys of healthcare facilities to ensure compliance with standards and...

The Lead, RN Case Manager is an experienced RN Case Manager who provides clinical and operational support to the Care Management leadership team. In addition to performing the full scope of an RN Case Manager, the Lead is...

CVS Health is seeking a Clinical Quality & Compliance RN for a remote role focused on quality, compliance, and operational excellence. You will ensure utilization management processes meet regulatory, accreditation, and quality standards,...

Working as a Nurse Case Manager at Cunningham Childrens Home means youll be part of team that is dedicated to supporting youth in critical need of emotional, psychological, and physical care. Located in Urbana, IL, Cunningham Children's Home is a...

When you join the growing BILH team, you're not just taking a job, you're making a difference in people's lives. This is a hybrid remote position with occasional float in-person at our Mount Auburn Primary Care offices in...

A leading Quality Improvement Consulting Company is seeking an RN Health Care Facility Surveyor to conduct compliance surveys across various healthcare facilities. The role is heavily focused on ensuring quality standards are met, involving...