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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...

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...

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...

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...

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...

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...

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...

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...

Molina Healthcare in Illinois seeks a licensed RN Case Manager to support Medicare members. This telephonic position may require occasional face-to-face visits; 25–40% travel may be needed depending on state requirements. You will assess, plan,...

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...

Providing telephonic case management, the fully remote Florida Licensed Nurse Consultant will manage medical care for workers' compensation injured employees, coordinating with medical providers and employers to facilitate their recovery and...

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,...

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...

Teleperformance is seeking a Healthcare Customer Service Representative to handle inquiries via phone, email, chat, and social media. The role focuses on de-escalation, issue resolution, and proactive payment processing while maintaining quality...

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...

Clinical Nurse Consultant At Bristol Myers Squibb, our employees often ask, "Who are you working for?"—a question that fuels collaboration, accountability, and urgency in our work. Our purpose-driven culture inspires us to discover,...

Job Title: Clinical Prior Authorization Reviewer Job Description This role focuses on reviewing prior authorization requests to determine the medical necessity of services and the appropriate level of care. The position ensures that...

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...

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...

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...

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...

Kingman Healthcare Incorporated (KHI)Staff Position Description Position Title: Utilization Review Nurse Position Code: RN-6027 Department: Case Management Safety Sensitive: Yes...