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Ensemble Health Partners is seeking an experienced RN for Utilization Review to assess medical necessity and optimize hospital and patient care. This remote role involves coordinating with the FCC, care management, and interdisciplinary teams to...

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...

Job Summary This position is responsible for ensuring compliance with Utilization Management (UM) and Quality Review (QR) functions performed by the health plan. The role supports clinical review activities requiring 5+ years of...

CVS Health is seeking a Utilization Management Nurse Consultant (Medical Review) to ensure members receive timely, medically necessary care through thoughtful clinical review and collaboration with providers. This fully remote role leverages your...

Ensemble Health Partners is seeking a Virtual Utilization Review Specialist to join our remote team. You will perform medical necessity reviews, manage denials, and coordinate with FCC and care management to optimize patient care while controlling...

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...

Centene Corporation is seeking a Licensed Practical Nurse (LPN) or Registered Nurse (RN) for a remote case management role in Pennsylvania. The selected candidate will perform concurrent reviews, determine appropriate care levels, and assist with...

Molina Healthcare is hiring a remote RN Care Manager. Preference for candidates in Washington State. This role will be working Pacific Standard Time hours. This role supports Medicare members through telephonic case management and...

Bring clinical insight, nursing expertise, and data-driven precision to a Hybrid/Remote Clinical Documentation Improvement Nurse Specialist career that combines meaningful patient impact, supportive leadership, modern healthcare technology,...

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...

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...

Medix is seeking a Remote Utilization Review Registered Nurse (UR RN) to bridge clinical care and hospital operations from a remote setting. Join a team optimizing patient care while safeguarding revenue integrity, with a compressed 4-day week,...

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 to analyze prior authorization requests from a remote location within the United States. The role evaluates medical necessity and appropriate level of care in line with national standards and contract...

Who We Are: Since 1985, BHCHP's mission has been to provide or assure access to the highest quality health care for all individuals and families experiencing homelessness in greater Boston. We care for over 11,000 homeless individuals each...

Amerit Consulting is seeking an experienced Utilization Management Nurse (RN) in California for a remote 6-month contract. The incumbent will support inpatient utilization review, medical necessity determinations, and facility claims compliance,...

IQVIA is seeking a Flex Nurse Educator to deliver remote patient education and in-field support during territory vacancies, supporting adherence and disease management. This is a non-clinical, educational role requiring an active RN...

Medical Review Nurse (RN)Remote position, however candidates must reside in the State of TX or State of ILThis position is a contract for about 9 months.Pay: $41/hourRN working in the insurance or managed care industry using medically accepted...

OPCO Skilled Management is seeking a Central Intake Nurse for a remote, full-time role. You will collect referral documentation from physicians, insurers, and providers to determine service appropriateness and coordinate patient care plans with...

HonorHealth is seeking an experienced Utilization Review RN Specialist for a remote-capable role serving the greater Phoenix area. The position focuses on reviewing medical necessity and coordinating reviews for diverse payers, ensuring...

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...

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...

Float Health is seeking an Intake Specialist to manage new patient referrals and coordinate start-of-care visits. This externally facing role requires quick action, clear communication, and meticulous attention to detail to ensure timely,...

Sentara Health Plans is hiring a Clinical Claims Reviewer RN for a remote role. The position is full-time, 40 hours, with standard hours 8am–5pm EST, Monday to Friday. Remote opportunities are available across many states, including New...

About HCSC At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers. Join HCSC and be...