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Registered Nurse (RN) For Utilization Management Team We are seeking a Registered Nurse (RN) to join our Utilization Management team. In this role, you will perform concurrent reviews, prior authorizations, medical necessity reviews,...

Responsible for utilization review work for emergency admissions and continued stay reviews Responsibilities Review and evaluate electronic medical records of emergency department admissions and screen for medical...

RN Coordinator Utilization Management The RN Coordinator Utilization Management will review submitted authorization requests for medical necessity, appropriateness of care, and benefit eligibility. This position reviews applicable...

North Memorial Health is seeking a Care Manager to coordinate clinically-based care across primary care and specialty clinics. You will ensure optimal care for complex cases, including acute and chronic disease management, across multiple health...

Employment Type: Full time Description: Our Trinity Health Culture: Knows, understands, incorporates & demonstrates our Trinity Health Mission, Values, Vision, Actions & Promise in behaviors, practices &...

Utilization Management Nurse Consultant Clinical Precertification RN (Medicare- Complex Spine Team) We're building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At...

Job Summary: The LVN Case Manager works under the direction of an RN following assessment, planning, facilitation and advocacy, which are achieved through collaboration with the client and other health care...

LVN Case Manager If you are as passionate about helping those in need as you are about growing your career, consider AltaMed. At AltaMed, your passion for helping others isn't just welcomed – it's nurtured, celebrated, and promoted,...

Contract Utilization Management Nurse IntusCare is the only end-to-end ecosystem built specifically to help Programs of All-Inclusive Care for the Elderly (PACE) programs deliver exceptional care, strengthen financial performance, and...

Remote Registered Nurse – Clinical Review Fully Remote | $48–$65/hr | Monday–Friday, 9:00 AM–6:00 PM ET Medix is supporting a healthcare technology organization that is adding experienced RNs to its clinical...

Registered Nurse:Utilization Review,16:00:00-04:30:00 Location: Torrance, California Type: Travel Job 17789408 Salary: $1,813 - $1,908/week Apply Now Acute Hospital...

About IntusCare IntusCare is the only end-to-end ecosystem built specifically to help Programs of All-Inclusive Care for the Elderly (PACE) programs deliver exceptional care, strengthen financial performance, and stay...

Supportive Housing Case Manager (Ages 18–25) The Supportive Housing Case Manager (Ages 18–25) supports young adults in securing and keeping stable housing while building life skills and independence. Using a positive, youth-centered...

Devoted Health Services, Inc. is seeking an experienced registered nurse to perform comprehensive clinical reviews across pre-service, concurrent, and post-service cases within a fast-paced Utilization Management environment. You will...

The position is work from home with field visits. JOB PURPOSE: This position is responsible for conducting medical management and health education programs for customers on government health care programs. Accountabilities include...

Piper Companies is seeking a Clinical Appeals Nurse to join a leading health insurance organization for a contract remote opportunity located in North Carolina. The Clinical Appeals Nurse will serve as a clinical...

Rio Hondo Subacute and Nursing Center in Montebello, CA is seeking a Full-Time Case Manager (LVN/LVN) to oversee care delivery from pre-admission to post-admission. You will ensure care coordination and appropriate utilization of services to...

Registered Nurse (RN) - Utilization Review | Remote | California License Required Position: Registered Nurse (RN) - Utilization Review (UM RN) Location: Torrance, CA (Remote Position)...

Humana seeks a Pre-Authorization Nurse to review prior authorization requests, perform medical necessity assessments, and educate providers on utilization processes. The role requires an active RN license (VA or compact with eNLC), 2+ years in...

Concurrent Review Registered Nurse (RN) Location: Fully remote. Our client is seeking an experienced Concurrent Review Registered Nurse (RN) to join its Utilization Management team. In this role, you will perform concurrent...

Job Opportunity Seeking a compassionate and driven Registered Nurse (RN) Care Manager to join our team in a role designed for nurses who are ready to expand their impact beyond the traditional clinical setting. This position offers the...

Centene is seeking an experienced RN (or LPN/LVN) with 4+ years in clinical nursing or case management to serve as a liaison for statewide appeals and external reviews. You will ensure NCQA and state compliance, prepare appeal letters, and...

About This Role The Palliative Care/Hospice Case Manager Utilization RN works collaboratively with physicians to coordinate patient admissions and discharges, ensuring appropriate care levels and resource use. This role is ideal for those...

Job Title Pay Rate: $27.50 per hour Work Mode: Fully Remote Duration: September to February with possible extension Responsibilities: Work telephonically with claimants, physicians, employers, and customers to ensure...

Job Description Responsible for the retrospective review of medical records and compiling data to validate quality of care, appropriateness of care , and accuracy of documentation. RN Peer Review Analyst will audit charts for...