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In addition to the responsibilities below, this position is also responsible for leading the implementation of best practice models; leading the implementation of patient care delivery systems and practice standards in several locations; delegating...

Job Description Join a team that's shaping the future of pediatric care. Children's Hospital Los Angeles is consistently ranked among the top 10 children's hospitals in the nation, delivering world-class care through more than 350...

The Veterans Health Administration at the Charleston VA Medical Center seeks a Nurse Manager (RN) to lead and supervise designated units within Community Care. The role emphasizes staff development, evidence-based practice, and collaboration with...

Actalent seeks a Care Management Coordinator (RN) to lead an Adult Case Management program in a primarily remote setting. You will supervise staff, drive quality initiatives, and ensure member-centered care delivery. The ideal candidate...

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...

Centene Corporation seeks an experienced RN Care Manager to assess, plan, and facilitate complex care management for members with primarily physical needs. The hybrid position requires residing in Delaware with an active RN license and in-person...

Hone is a virtual medical clinic for men's/women's health, hormones, weight loss, and longevity.We are remote-first and fast-growing, focused on candid communication and joy.The Role:You will manage patient-doctor communications and clinical...

Cunningham Children's Home in Urbana, IL, is seeking a Nurse Case Manager to support youth with emotional, psychological, and physical care in residential programs. You will provide medical case management, screening, education, counseling, and...

HonorHealth is seeking an Utilization Review RN Specialist to review and monitor the utilization of health care services, ensuring medical necessity and appropriate levels of care. You will coordinate reviews for Medicare, AHCCCS, self-pay, and...

Are you passionate about serving seniors? Do you want to be part of team that strives to create experiences that celebrate our seniors?

Utilization Management Registered Nurse (RN) - Remote Full-time WHO IS GUIDEHEALTH? Guidehealthis a data-powered, performance-driven healthcare company dedicated to operational excellence. Our goal is to make...

CVS Health is seeking a Care Manager in Illinois to advocate for members enrolled in Medicare/Medicaid, coordinating care with providers, community organizations and family supports to address complex health and social needs. This role focuses on...

Humana is seeking a Utilization Management Nurse to support coordination, documentation, and communication of medical services and benefit determinations. This role suits experienced nurses who can work independently and make critical patient-care...

Cambia Health Solutions is seeking an experienced Utilization Management Nurse to support clinical reviews and care coordination across Oregon, Washington, Idaho, and Utah. This role emphasizes medical necessity determinations and collaboration...

Ethos Risk Services is seeking a full-time Clinical Recruiter (REMOTE) to lead hiring for the Case Management division. You will own full-cycle recruiting for nurse case managers and other clinical pros, from posting to onboarding, ensuring a...

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,...

Optum is seeking a Registered Nurse with managed care experience to evaluate outpatient services and determine appropriate care in a remote role within the United States. You will translate complex medical guidelines into actionable care decisions...

Job Title : Registered Nurse (Navy Nurse Corps) Category / Component : Officer • Both Overview Navy Nurse Corps officers deliver professional nursing care to service members, families, and global communities in leading edge military medical...

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...

Registered Nurse (RN) For Utilization Management Team We are seeking a Registered Nurse (RN) to join our Utilization Management team. In this role, you will perform concurrent reviews, prior authorizations, medical necessity reviews,...

Details Client Name Dignity Health California Hospital Medical Center Job Type Travel Offering Nursing Profession Nursing...

University Hospitals is seeking a Registered Nurse to collaborate with the health care team to coordinate admissions, continued stays, and level-of-care decisions. You will communicate with patients and families to ensure timely care and proper...

Provide essential clinical and administrative support to a remote healthcare team across Canada. Manage laboratory results, pharmacy communications, referrals, and patient follow-ups. Requirements: Current...

Benefits: 401(k) Competitive salary Dental insurance Health insurance Paid time off Signing bonus Training & development Vision insurance Outpatient Case Management West Los Angeles VAMC 11301...

Emanate Health in Covina, CA, seeks a Utilization Review Nurse to evaluate medical records and determine medical necessity using policies and guidelines for urgent and standard reviews. You will document decisions and support claims reviews,...