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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...

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...

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...

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...

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...

Humana is seeking a Pre-Authorization Nurse to review requests for medical necessity and level of care, working remotely from Virginia or a compact-licensed state. You will educate providers, document clinical data, and make independent...

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...

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...

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,...

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...

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

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...

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...

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...

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...

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...

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...

Overview Our client is a trusted leader in healthcare services, dedicated to improving outcomes for patients and providers through innovative solutions and high-quality care. Join a team committed to making a meaningful difference in the...

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,...

Medlivo is seeking a travel nurse RN Utilization Review for a travel nursing job in Downey, California. Job Description & Requirements Specialty: Utilization Review Discipline: RN Duration: 13 weeks 40 hours per week Shift: 8 hours, days Employment...

Family Advocate Support Care - Senior Clinical Admin Nurse At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of...

Utilization Management Nurse Consultant Clinical Precertification RN (Medicare Home Care) Remote | Full-Time | Weekday Schedule We're building a world of health around every individual - shaping a more connected, convenient and...

IPRO in New Rochelle, NY seeks a Nursing Home Surveyor/Complaint Investigator to assist NYSDOH with surveillance and investigations at nursing homes and TCUs. The role involves reviewing abuse eglect allegations, preparing reports, and ensuring...

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...