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We are more than a health system. We are a belief system.We believe wellness and sickness are both part of a lifelong partnership, and that everyone could use an expert guide. We work hard, care deeply and reach...

JOB DESCRIPTION Job Summary The RN Clinical Appeals Nurse provides support for internal appeals clinical processes ensuring that appeals requests are reevaluated in alignment with applicable federal and state regulatory...

Job Summary Leads and supervises multidisciplinary team of healthcare services professionals in some or all of the following functions: care management, utilization management, behavioral health, care transitions, long-term services and...

Job Opportunity at Highmark Inc. This job implements effective utilization management strategies including: review of appropriateness of health care services, application of criteria to ensure appropriate resource utilization,...

RN Lead Position is remote (US/Canada) No agencies please Maximus is a mission-driven consumer performance medicine telehealth company that provides men and women with content, community, and clinical support to optimize...

The RN Case Manager is responsible for coordinating continuum of care activities for assigned patients and ensuring optimum utilization of resources, service delivery, and compliance with medical regime. Essential Duties and...

Wolters Kluwer is a global leader in professional information services that combines deep domain knowledge with specialized technology. Our portfolio offers software tools coupled with content and services that customers need to make decisions...

Overview What you can expect! Find joy in serving others with IEHP! We welcome you to join us in healing and inspiring the human spirit and to pivot from a job opportunity to an authentic...

At CVS Health, were building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nations leading health solutions company, we reach millions of...

Employment Type: Part timeShift: 12 Hour Night Shift Description: Saint Joseph Health System is proud to offer Daily Pay. Work Today, Get Paid...

About Outpatient Clinics Corewell Health operates over 300 outpatient clinics across Michigan, bringing a multitude of care options to the communities that we serve. There are over 40 different types of primary care and specialty...

A leading healthcare organization is seeking a Senior LTSS Assessor (RN) to conduct assessments and coordinate care for complex populations. This remote role requires strong care management and communication skills, along with a Bachelors degree...

Job Opportunity At Highmark Inc. Job Summary: This job implements effective utilization management strategies including: review of appropriateness of health care services, application of criteria to ensure appropriate resource...

Join BoldAge PACE and Make a...

This range is provided by Insight Global. Your actual pay will be based on your skills and experience talk with your recruiter to learn more. Base pay range $140,000.00/yr - $170,000.00/yr Direct message the job poster from...

Bridge Nurse Requirements Normal 0 false false false EN-US X-NONE X-NONE Graduate of an accredited school of nursing required. Licensed as a Registered Nurse (RN) or Licensed Practical Nurse (LPN) in the State of Ohio required. A minimum of one-year...

A healthcare provider is seeking a Clinical Specialist to work remotely from Melville, NY. This role involves collaborating with healthcare teams to ensure compliance and patient care standards, preparing documentation for care levels, and...

A major healthcare provider is seeking a Clinical Advisor, RN for a remote position. This role involves analyzing population health data, delivering impactful presentations to clients, and making strategic recommendations to improve healthcare...

A leading healthcare provider is urgently seeking experienced Clinical Documentation Specialists for remote positions. Ideal candidates must be RN graduates from an approved nursing program and possess prior CDI experience, preferably in acute...

Immediate Hiring for Remote Clinical Review Nurses Immediate hiring for remote clinical review nurses. Review approximately 20 cases a day for medical necessity. Advocate for and protect members from unnecessary hospital admissions.

Description As an RN Care Manager, you will function as a clinician, advocate, and educator to achieve optimal clinical and quality outcomes by effectively managing care and resources to reduce unnecessary utilization. The RN Care Manager...

The position is work from home with field visits. JOB PURPOSE: This position is responsible for conducting medical management and health education programs for customers on government health care programs. Accountabilities include...

Registered Nurse, Quality Assurance Reviewer The Registered Nurse, Quality Assurance Reviewer will work in conjunction with the Quality Manager and will be responsible for completing quality reviews for the Clinical Services and Provider...

Job Details Sr. Performance Improvement Program Manager (RN) Monday-Friday - (Day Shift) Newark DE ChristianaCare is seeking a Senior Performance Improvement Program Manager (RN) to join our...

A leading health solutions company is seeking a Remote Telephonic Case Manager in Denver, CO. This role requires a Registered Nurse with 5+ years of experience and expertise in areas such as Oncology and Specialty Pharmacy. Candidates must...