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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...

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,...

Mass General Brigham Health Plan Holding Company, Inc. is seeking an RN-based Utilization Management Nurse to support network adequacy reviews and authorization decisions for ACO, HMO, and EPO products. The role emphasizes medical necessity...

Elevance Health in Denver, CO seeks a Wellness Nurse Consultant to develop and manage health programs for federal employees under the Federal Employee Program. The role is field-based with travel to client sites and occasional home-office work,...

A healthcare technology company seeks an experienced Registered Nurse for a remote role providing clinical technology services. This position is for independent contractors, focusing on chart reviews and clinical data analysis. Candidates should...

Leading cross-functional initiatives, the full-time RN Medical Coding Consultant will research and develop clinical services, manage episodic projects, and support the implementation of medical policies and coding practices while working...

MaziCTools is seeking a Freelance Utilization Management Nurse Consultant to work remotely in the United States. This full-time role requires an active RN licensure and 3+ years of clinical experience. Responsibilities include assessing healthcare...

Alliance Health in North Carolina is seeking a Telework-enabled Care Management Consultant who will provide secondary care coordination and medication reviews for members with physical health needs. The role requires licensure in NC (RN or OT/PT)...

St. Joseph Mercy Health System is seeking a Registered Nurse Education Coordinator to join the FirstChoice Iowa Regional program as a remote leader in nursing education. This full-time role supports curriculum design, staff development, and...

MaziCTools is seeking a Freelance Utilization Management Nurse Consultant to work remotely in the United States. This full-time role requires an active RN licensure and 3+ years of clinical experience. Responsibilities include assessing healthcare...

Nursing Assistant PositionUnder the direction of a Registered or Licensed Vocational Nurse, provides basic nursing care and implements selected aspects of the patients nursing plan of care.This position requires providing care/service to an...

Responsibilities: How you'll change lives...

JOB DESCRIPTION Candidates must hold a current California license, 2-3 years case management exprience reside in the San Diego, California area, and be able to...

A healthcare staffing company is seeking a Remote Registered Nurse (RN) to specialize in triage on a PRN basis. Ideal candidates will have at least 1 year of nursing experience and an active RN license. Responsibilities include conducting patient...

Walker Healthforce, LLC seeks a Medical Claim Review Nurse for a fully remote contract based in Washington. The role focuses on retrospective medical necessity reviews, appeals, and payment integrity within Molina Healthcare of Washington.

Registered Nurse Navigator - Cancer Center Exams - 10 Hour Days Do you have a passion for the highest clinical quality and patient happiness? Would you like to use your expert clinical competencies with an organization known nationally...

When you join the growing BILH team, you're not just taking a job, you're making a difference in people's lives. This is a hybrid remote position with occasional float in-person at our Mount Auburn Primary Care offices in...

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...

A leading Quality Improvement Consulting Company is seeking an RN Health Care Facility Surveyor to conduct compliance surveys across various healthcare facilities. The role is heavily focused on ensuring quality standards are met, involving...

To ensure the highest quality and integrity of peer review case reports, the full-time Remote RN Clinical QA Coordinator will perform quality assurance reviews, verify compliance with client specifications and regulatory standards, and support the...

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,...

Description The Nurse Navigator is a professional Registered Nurse who assumes responsibility and accountability for a group of patients for a designated time frame and provides care to these patients using the nursing...

A quality improvement consulting company is seeking an RN Health Care Facility Surveyor to work remotely with up to 75% travel. Responsibilities include conducting surveys of healthcare facilities to ensure compliance with standards and...

A leading health care provider is seeking a Massachusetts Telehealth Nurse to assist patients in accessing care through phone consultations. Candidates must have a valid RN license in Massachusetts and 3+ years of clinical experience. The ideal...

Cadence is looking for a Clinical Navigator (Licensed Practical Nurse) to provide virtual chronic care support for Medicare patients. The role involves conducting patient outreach, documenting interactions in the Cadence platform, and ensuring...