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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...

Responsibilities: How you'll change lives...

Santa Barbara Cottage Hospital is seeking a licensed practical nurse to join BHPS Utilization Management as a remote reviewer of medical necessity and benefit determinations. You will assess cases using clinical guidelines and coordinate with...

Nurse Care Manager Locations: Los Angeles, California Job Category: Registered Nurse Position Type: Full-Time Shift: Days Job Description Join a team that's shaping the...

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...

Details Client Name Kaiser Permanente Los Angeles Medical Center Job Type Permanent Offering Nursing Profession Nurse...

CVS Health is seeking an experienced Utilization Management Nurse Consultant for a 100% work-from-home, full-time position open to MST/PST residents. You will coordinate and document utilization and benefit management activities, ensuring timely,...

Highmark Inc. is seeking an experienced RN in a remote role, with weekend availability on Saturdays and Sundays plus three weekdays. The position emphasizes utilization management, care coordination, and provider/member education. The RN...

Nexus Health Systems is seeking a seasoned Utilization Review Registered Nurse (UR RN) for a fully remote role in the US. The ideal candidate will have experience in utilization review, case management, or behavioral health, and will ensure...

Brighton Health Plan Solutions seeks an experienced Utilization Management Nurse (LPN) to perform medical necessity and benefit reviews remotely. You will work within UM processes, coordinate with partners, and ensure timely, compliant...

Centene is seeking a licensed Practical Nurse or Registered Nurse for a remote utilization management role based in Oklahoma. You will review prior authorization requests for medical necessity and coordinate with medical teams to ensure...

Seeking a part-time Utilization Review Nurse RN, the candidate will perform medical-necessity reviews and level-of-care determinations, ensuring compliance with established guidelines while working up to 28 hours per week, including weekends.Key...

Kindred Hospital Paramount and Acute Rehabilitation Unit (ARU) is 177-bed hospital. With 159 long-term acute care hospital (LTACH) beds, we offer the same in-depth care you would receive in a traditional hospital, but for an extended recovery period.

Your Role The Care Management team independently manages complex and high-risk care management cases by applying advanced clinical judgment to assess medical necessity, develop cost-effective care plans, and support...

CVS Health is seeking a Clinical Quality & Compliance RN for a remote role focused on quality, compliance, and operational excellence. You will ensure utilization management processes meet regulatory, accreditation, and quality standards,...

Kindred Hospital Paramount and Acute Rehabilitation Unit (ARU) is 177-bed hospital. With 159 long-term acute care hospital (LTACH) beds, we offer the same in-depth care you would receive in a traditional hospital, but for an extended recovery period.

Cross Country Education is seeking a local contract nurse RN School RN for a local contract nursing job in Downey, California. Job Description & Requirements Specialty: School RN Discipline: RN Duration: 41 weeks 36 hours per week Shift: 12 hours...

Registered Nurse - Primary Care Location: Long Beach, CA Schedule: Monday-Friday, 8:00 AM-5:00 PM Setting: Onsite Position Summary We are seeking an...

A healthcare solutions provider is looking for a qualified RN to perform medical reviews and coordinate care for members. This role involves assessing service needs, engaging in patient education, and ensuring compliance with healthcare...

The Clinical Staff PACU Nurse is a skilled and experienced professional Registered Nurse (RN) responsible for excellence in the clinical practice of nursing and the management of patient care. Working under the supervision of the the Clinical Unit...

Company Details Berkley Medical Management Solutions (BMMS) provides a different kind of managed-care service for W.R. Berkley Corporation. We believe focusing on an injured worker's successful and speedy return to work is good for people...

Overview Join an award-winning team of dedicated professionals committed to our core values of quality, compassion and community! Garden Grove Hospital Medical Center, a member of Prime Healthcare, offers incredible opportunities to expand...

Job Title: Contingent Clinical Care LVN/LPN PT - MC Address: Burbank, CA Job Description Administer oral, injectable, intravenous, and topical medications. Evaluate complex patient conditions and document treatment responses. Perform routine...

Utilization Management Nurse Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people...

GQR Healthcare is seeking a local contract nurse RN Case Management for a local contract nursing job in Los Angeles, California. Job Description & Requirements Specialty: Case Management Discipline: RN Start Date: ASAP Duration: 13 weeks 40 hours per...