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Job Description & Requirements Women's Health Nurse Practitioner (NP) StartDate: ASAP Available Shifts: Day 8 Pay Rate: $82.45 - $89.25 This facility is seeking a Women's Health Nurse Practitioner (NP) for locum tenens support...

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...

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 current RN license, nursing diploma or...

Humana is seeking a Pre-Authorization Nurse for remote work to review prior authorization requests and determine appropriate care following guidelines. The role involves clinical judgment, data entry in management systems, and collaboration with...

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...

The RN Clinical Educator, Ancillary Services is an advanced clinical expert in Cath Lab and procedural-based services who supports...

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...

Trillium Health Resources is seeking a Population Health Nurse to provide clinical care management and population health support for assigned members, focusing on prevention, wellness, and outcomes. The role uses nursing judgment as an RN to...

Humana Inc. is seeking a Pre-Authorization Nurse to review prior authorization requests, determine medical necessity, and educate providers on utilization management processes. The role requires clinical judgment, independent decision...

CVS Health is seeking an RN Utilization Management Nurse Consultant for a 100% remote role. The incumbent coordinates, documents and promotes utilization/benefit management to ensure appropriate care and timely discharge planning, in a workload...

Job Title: Clinical Prior Authorization Reviewer Job Description This role focuses on reviewing prior authorization requests to determine medical necessity and appropriate level of care in alignment with national standards,...

Yoh is seeking a Utilization Management Nurse Coordinator (RN or LVN) for a 6+ month remote contract with a managed care client based in Northern California. Training occurs onsite in Fairfield or Redding for three weeks, then transitions to fully...

Job Title: Registered Nurse (RN) Disease Manager Job Overview: The Registered Nurse (RN) Disease Manager is responsible for coordinating care and managing the health outcomes of patients with chronic or...

WORK REMOTELY after training! CANDIDATE MUST RESIDE IN THE METROPOLITAN NEW YORK AREA! !! Process all requests for services in accordance with Medicare and NYS Medicaid guidelines as well as departmental criteria and...

Sagility is hiring an RN Utilization Management Reviewer for a fully remote, home-based role in the United States. You will perform day-to-day clinical and service authorization reviews for medical necessity and ensure compliance with CMS...

DRG Specialist UPMC Corporate Revenue Cycle is hiring a DRG Specialist to work on inpatient auditing within our Coding Department. This position will be a work-from-home position working during standard business hours Monday through...

CVS Health Corporation seeks an experienced Registered Nurse (RN) to support 24/7 Utilization Management operations. You will review cases, assess medical necessity, coordinate care, and ensure members receive appropriate, high-quality healthcare...

Remote Utilization Review Registered Nurse (UR RN) Are you an experienced RN looking to transition away from the bedside while still making a massive impact on patient care? We are seeking a dedicated Utilization Review Nurse to join our...

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...

Virginia Mason Medical Center in the Puget Sound region seeks a Clinical Documentation Review Specialist (RN) to clarify patient records for appropriate reimbursement and care complexity. You will conduct concurrent reviews and engage with...

Schedule: Flexible Shifts! You provide your manager with the days and start/end time you are available to complete your hours. All United States time zones are welcome. PRN opportunity to work 20-30hrs per week Job Location Type:...

Elevance Health is seeking a Utilization Management Representative I to coordinate precertification and prior authorization reviews. This full-time role supports calls, post services work, and data entry into the UM system with accuracy and...

Bon Secours Mercy Health is seeking an RN Infection Prevention professional to manage system-wide IPC activities, ensuring compliance with regulatory standards. This role supports outbreak investigation, surveillance, and performance improvement...

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 applies clinical judgment to assess documentation, determine...

Case Manager Utilization RN Works collaboratively with an MD to coordinate and screen for the appropriateness of admissions and continued stays. Makes recommendations to the physicians for alternate levels of care when the patient does...