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A healthcare service provider is seeking a Registered Nurse - Case Review Specialist to provide remote support in reviewing cases for Federal Occupational Health. The ideal candidate will have at least 5 years of Nursing experience, a valid RN...

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,...

A leading healthcare organization is looking for a Nurse Reviewer I to conduct preauthorization and appropriateness of treatment reviews for diagnostic imaging services. The role supports remote work and requires an associate degree in nursing...

Medical Review Nurse The Medical Review Nurse provides support for medical claim and internal appeals review activities - ensuring alignment with applicable state and federal regulatory requirements, Molina policies and procedures, and...

Clinical Claims Review At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better.

Provide support to all units within Claims to ensure all clinical components are met for CMS, NCQA, URAC, DOL, DOI, and all other State and Federal entities. Identify business priorities and necessary processes to triage and deliver work. Use...

A healthcare staffing company in Sacramento is seeking a qualified RN Case Manager to coordinate care, manage complex cases, and mentor fellow nurses. Candidates must possess an active California RN license and a strong understanding of managed...

Nurse Navigator 1 - Site Disease - Full Time/Remote page is loaded## Nurse Navigator 1 - Site Disease - Full Time/Remotelocations: Miami, FLtime type: Full timeposted on: Posted Todayjob requisition id: R100091779## **Current Employees:**If you...

A leading health company is seeking a Telephonic Nurse Case Manager II responsible for managing care for members with chronic needs. The position requires a BA/BS in a health-related field, a current RN license, and five years of clinical...

JOB DESCRIPTION Job Summary The Delegation Oversight Nurse provides support for delegation oversight quality improvement activities. Responsible for overseeing delegated activities to ensure compliance...

A state government agency in Florida is seeking a Registered Nurse Specialist to support foster children with complex medical needs. The role involves conducting assessments, home visits, and collaborating with caregivers and healthcare teams.

A global risk and claims management company is seeking a part-time nurse in Lansing, Michigan. The role involves triaging calls, providing advice on care, and ensuring the safety of patients. Ideal candidates will have a BSN and an active RN...

Medical Review Nurse The Medical Review Nurse provides support for medical claim and internal appeals review activities - ensuring alignment with applicable state and federal regulatory requirements, Molina policies and procedures, and...

Performing pre-service clinical coverage review of services (predetermination reviews), using applicable benefit plan documents, evidence-based medical policy and nationally recognized clinical guidelines and criteria. Managing clinical Out of...

Cvs Health Care Manager At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation's leading health solutions...

Registered Nurse (RN) Outpatient Clinic- Float Team - Hybrid/Partially Remote The RN is responsible for providing clinical support to providers and patients in Clinical Practice Group (CPG) office. These duties may include: patient care,...

Remote position, however, candidates must reside in the State of TX or State of IL. This position is a contract for about 9 months. Pay: $41/hour Job Responsibilities: RN working in the insurance or managed...

Medical Review Nurse The Medical Review Nurse provides support for medical claim and internal appeals review activities ensuring alignment with applicable state and federal regulatory requirements, Molina policies and procedures, and...

A prominent medical institution is seeking a Nurse Rev II to conduct clinical assessments and evaluations for individuals in nursing facilities. This hybrid role includes statewide travel and offers flexible scheduling with no weekends or...

Medical Review Nurse The Medical Review Nurse provides support for medical claim and internal appeals review activities ensuring alignment with applicable state and federal regulatory requirements, Molina policies and procedures, and...

Remote position, however, candidates must reside in the State of TX or State of IL. This position is a contract for about 9 months. Pay: $41/hour Job Responsibilities: RN working in the insurance or managed...

A leading healthcare provider in Winston-Salem is seeking a Telehealth Nurse to provide nursing services remotely. Applicants should have a valid RN license and at least 3 years of clinical experience, preferably in telephone triage. Strong...

Company Overview: Join an innovative startup health plan based in Wisconsin that is revolutionizing healthcare and empowering companies to combat the relentless rise in healthcare costs. Our mission is to provide accessible, high-quality...

Join to apply for the RN Call Assist Remote in PST role at Optum 1 day ago Be among the first 25 applicants Join to apply for the RN Call Assist Remote in PST role at...