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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 sponsorshipLocation: 100% Remote for California...

Job Summary: As the leader of the health care team, provides professional nursing care, utilizing the nursing process in accordance with established standards of care, policies, and procedures. Demonstrates performance...

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...

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...

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...

Registered Nurse-Remote Patient Monitoring Home Telehealth Case Manager Department: Department of Veterans Affairs The Remote Patient Monitoring Home Telehealth Case Manager delivers fundamental knowledge-based...

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 sponsorshipLocation: 100% Remote for California...

CVS Health is seeking a Utilization Management Nurse Consultant (Medical Review) to ensure members receive timely, medically necessary care through thoughtful clinical review and collaboration with providers. This fully remote role leverages your...

Actalent is seeking an experienced Utilization Review RN for a remote MondayFriday opportunity with a CA-based license requirement. The role reviews clinical information, applies criteria, and makes first-level recommendations to ensure regulatory...

About This Role As an Inpatient Care Management Nurse, you will be responsible for ensuring proper utilization of health services by assessing and interpreting member needs and identifying solutions to help members live healthier lives.

We are sharing a specialised remote consulting opportunity for experienced Registered Nurses with strong expertise in inpatient clinical care, nursing documentation, medical record review, clinical judgment, and healthcare quality assurance to...

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...

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...

Bring your clinical expertise. Raise the standard. Add LIFE to the years of the people we serve. VitaCare Living is seeking an experienced Registered Nurse (RN) to support our assisted living and memory care communities in Stratford,...

UnitedHealth Group is seeking a Registered Nurse in the Weslaco, TX area to assess, plan, and implement person-centered care strategies while coordinating with providers and community resources. Remote work flexibility is available within the...

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 to...

Humana is seeking a Utilization Management Registered Nurse to interpret and support coordination, documentation and communication of medical services and benefit determinations for post-acute care services including SNF, home health and DME.

It takes great medical minds to create powerful solutions that solve some of healthcare's most complex challenges. Join us and put your expertise to work in ways you never imagined possible. We know you've honed your career in a fast-moving...

Sentara Health Plans seeks a Clinical Claims Reviewer RN for remote work. You will perform utilization management, review pre/post payment claims and authorizations for inpatient/outpatient cases, and address provider inquiries with appropriate...

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...

RN opportunity with out the bedside burnout + sign on bonus. This Jobot Job is hosted by: Dexter Dionio Are you a fit? Easy Apply now by clicking the "Apply" button and sending us your resume. Salary: $80,000 -...

CVS Health is seeking a Medicare Precertification Utilization Management Nurse Consultant in the Baltimore area. The role leverages RN clinical expertise to assess care options, determine coverage, and coordinate communications with providers.

Agency Dept of Health and Human Services Division Health Service Regulation Job Classification Title Nurse Consultant I (NS) Position Number 60090392 Grade MH16...

Join Us at our Virtual Job Fair to learn more about this position! Tuesday, November 3rd | 12pm - 2pm CDT Register here: At UnitedHealthcare, we are simplifying the health...

Jobgether, on behalf of a partner organization, seeks an experienced Registered Nurse for a remote Utilization Management role. You will review cases, assess medical necessity, and support prior authorization decisions while collaborating with...