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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...

LanceSoft is seeking a travel nurse RN Clinic for a travel nursing job in Glendale, California. Job Description & RequirementsSpecialty: ClinicDiscipline:...

Prime Staffing is seeking a travel nurse RN Research / Clinical Research for a travel nursing job in Fullerton, California. Job Description & RequirementsSpecialty:...

A global talent management firm is seeking a Utilization Review Nurse for a contract role based in Pennington, NJ. The role involves performing utilization management, reviewing medical records, and coordinating discharge planning. Candidates must...

Molina Healthcare is seeking a Wisconsin-licensed RN for a remote IRIS Self-Directed Personal Care (SDPC) role. You will oversee a group of IRIS participants, assess needs, and educate providers and participants in their homes and communities.

Job Title: Nurse, Clinical Medical Review Location: Columbia, MD (Primarily remote, but hybrid) Duration: 6 Months Contract PURPOSE: We are seeking a qualified RN or LPN with experience supporting HEDIS reporting and abstraction processes in a...

JOB DESCRIPTION We are searching for six TX licensed RNs to work telephonically with our Medicaid members across the state. Three of the positions are open to RNs with at least two years of experience in in Behavioral Health or Substance...

IPRO seeks a Nursing Home Surveyor/Complaint Investigator to support the NYSDOH Office of Aging and Long-Term Care. The role involves surveillance and investigation of nursing homes, ensuring quality of care, and preparing defensible...

Position: Remote Nurse Consultant Company Overview: Absolute Elder Care is a leading provider of in-home care services for seniors. Our mission is to provide compassionate, personalized care to help seniors maintain their...

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...

Allina Health is seeking a Nurse Informaticist to join the Information Systems Optimization Solutions team. The role focuses on integrating nursing practice with data science to improve patient outcomes and care quality across inpatient and...

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...

Health Care Service Corporation is hiring a Nurse Liaison I for Utilization Management & Quality Review. This remote nationwide role supports clinical review activities, benefit determinations and medical necessity assessments, ensuring compliant,...

IQVIA LLC is seeking a Flex Nurse Educator to support patient education remotely with in-field coverage as needed. The role emphasizes non-clinical, educational interactions and adherence improvement, while maintaining privacy and high educational...

Ensemble Health Partners seeks a Manager for Utilization Review to lead the centralized Virtual Utilization Management program, coordinating clinical and operational excellence in authorizations, denials, and appeals for inpatient, observation,...

US Health Partners, LLC seeks a Nurse liaison to coordinate care and communicate medical information among the Injured Worker, the Insured, and the Carrier to facilitate treatment, rehabilitation, and return to work. This is a remote, field-based...

Self Fund Health Nurse Navigator Remote · Full time The Nurse Navigator is a remote WI-based RN who acts as the member's single point of contact through the healthcare system — coordinating care, advocating for patients, and steering...

Medix is seeking a registered nurse for Utilization Review (UR) on a remote, full-time basis. The role involves medical necessity and level-of-care reviews across all ages, with a 4x10 schedule and every-other-weekend requirement. Evening hours...

Southcoast Health seeks a Team Lead-Centralized Clinic Support to join a remote role serving MA/RI communities. The role guides nursing staff, ensures clinical workflow compliance, and drives care coordination and patient safety across ambulatory...

Program Integrity Clinical Compliance AuditorOptum Insight is improving the flow of health data and information to create a more connected system. We remove friction and drive alignment between care providers and payers, and ultimately consumers.

SafeGuard Services (SGS), a Peraton subsidiary, seeks a Nurse Reviewer Team Lead to guide medical reviews and fraud investigations within the SGS team. You will oversee workload, mentor staff, and coordinate with investigations to develop cases...

Family Service of Rhode Island (FSRI) seeks a per diem School Nurse to join our multidisciplinary team in Exeter, RI. The nurse provides healthcare services to students and staff, manages health needs, responds to emergencies, and supports...

Arizona Arthritis & Rheumatology Associates, P.C. is seeking a Clinical Research Nurse to manage unblinded protocols, prepare investigational medications, and travel to multiple sites. The CRN will ensure compliance with protocols and SOPs, and...

Trustaff is seeking a travel nurse RN Clinic for a travel nursing job in Los Angeles, California. Job Description & RequirementsSpecialty: ClinicDiscipline:...

Staffing Solutions Organization LLC (SSO) is seeking a Nurse Reviewer to conduct provider compliance reviews, onsite visits, and evaluate documentation to ensure adherence to state regulations and program requirements. You will work independently...