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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...

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...

JOB DESCRIPTION Job Summary Provides support for care management/care coordination activities and collaborates with multidisciplinary team coordinating integrated delivery of member care across the continuum. Strives to ensure member...

CVS Health is seeking an ICM Care Manager to assess, plan and coordinate patient care from a home-based setting with 25-50% travel within Passaic County, NJ. The role requires an active NJ RN license and a minimum of 3 years clinical experience,...

Lead the day-to-day operations of a remote team of RNs and LPNs responsible for reviewing and resolving real-time patient alerts across remote monitoring workflows.Monitor queue performance, alert resolution times, throughput, billable activity,...

Job DescriptionJob Summary Provides support for clinical facility site reviews. Under the supervision of leadership, uses clinical judgement within appropriate scope to independently conduct reviews and other monitoring activities...

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...

Case Manager Utilization RNWorks 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 not meet the...

When you join the growing BILH team, you're not just taking a job, you're making a difference in people's lives. **This position is remote. Candidates must be local to New England States for consideration** The Clinical...

Virtua Health is seeking a remote RN to support the application of medical necessity tools, ensuring compliance and achieving positive patient outcomes. You will collaborate with Physician Advisors, manage denials, and document review activities...

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...

Description: Job Summary: 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...

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...

RN Care Coordination Inspired by faith. Driven by innovation. Powered by humankindness. CommonSpirit Health is building a healthier future for all through its integrated health services. As one of the nation's largest nonprofit Catholic...

Humana is seeking a skilled Utilization Management Registered Nurse to interpret and coordinate medical services and benefit determinations for post-acute care such as SNF, Home Health, and DME. You will report to the Manager of Utilization...

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...

Job Description You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you'll have access to competitive...

Overview Utilization Management for the assigned inpatient Care Management population. This position is designed to facilitate an effective process of the Mercy Care Management model; supporting quality patient care, safety and financial...

Job Summary and Responsibilities As our RN Care Coordinator, you will be a central figure in patient care, seamlessly navigating the healthcare journey to achieve optimal outcomes and an exceptional patient...

Staffmark Group is recruiting a Registered Nurse for a remote role. Primary duties include reviewing peer review reports, ensuring evidence-based rationales, and ensuring compliance with client, contract, and regulatory standards. The ideal...

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...

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,...

EK Health is hiring a full-time Telephonic Nurse Case Manager (RN) for our Case Management Team. The role includes assessing, planning, coordinating, and evaluating service options to ensure injured workers receive timely, cost-effective care and...

RN opportunity with out the bedside burnout + sign on bonus. This Jobot Job is hosted by: Dexter Dionio Are you a fit? Easy Apply now by clicking the "Apply" button and sending us your resume. Salary: $80,000 -...

ADP, Inc. is seeking an Outpatient Case Manager to provide intake and case management for members with chronic conditions and related comorbidities. You will develop individualized care plans with the member, caregiver, and PCP, and coordinate...