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Arkansas Blue Cross and Blue Shield seeks an Appeals Coordinator with a strong nursing background to review adverse benefit determinations within regulatory timeframes. You will apply medical guidelines and corporate policies, drawing on HCPCS/CPT...

Nurse - Clinical Review Performs utilization review of cases to determine if the request meets medical necessity criteria in accordance with medical policies agreed upon with the Client and any applicable governing body. Facilitates...

RN CDI Specialist As one of the Top 8 Most Innovative Healthcare Systems in Becker's Hospital Review, we're working to create a national model for improving health. Today, we're focused on bringing our region services that improve every...

A leading organization in healthcare quality is seeking a Clinical Quality Reviewer to review clinical cases and identify potential quality or safety concerns. This remote position is ideal for licensed clinical professionals with a strong...

The Leading Provider of Integrated Occupational Medicine Services CORE Health Networks, the recognized leader in Integrated Occupational Medicine Services, provides integrated solutions to your occupational healthcare needs. Our...

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 millions of people for the better. Come build the health care system...

Public Health Nurse The County of Los Angeles Department of Public Health is seeking qualified candidates to fill emergency Public Health Nurse vacancies related to the homelessness crisis. Under the emergency order, applicants who...

Exceptional care starts with exceptional people. For us, this is more than a job– it's a calling. It's waking up each day, looking for ways to make a difference with a compassionate, inclusive and talented team. Ochsner empowers you...

Job Summary: We seek a highly skilled and experienced Registered Nurse with specialties in Medical/Surgical, ICU, ER, Psychiatric, Labor & Delivery, PACU, or Operating Room to perform utilization review duties. The Registered...

Licensed Vocational Nurse - Home Health Excell Home Care is actively recruiting for LVN Case Manager. Our innovative company is focused on the best possible outcomes for our patients, outstanding and highly personalized patient care, and...

MCMC is seeking an RN/LPN/LVN with a clinical background to join as a Clinical Quality Assurance Coordinator, performing QA reviews of peer reports from home. You will ensure evidence-based rationales, accurate client instructions, and standards...

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...

CVS Health is seeking a Telephonic RN Case Manager to support members across the United States from a remote work setup. You will coordinate care with patients and their care teams, applying guidelines and reviewing medical necessity to optimize...

UnitedHealth Group is seeking a Service Coordination Manager, RN in El Paso, TX. This role provides oversight of service coordination staff and ensures timely delivery of non-waiver and waiver services for Star+Plus members. The position...

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...

Overview California Institute for Rehabilitation A joint venture partnership between Select Medical, UCLA, and Cedars Sinai Location: Los Angeles, CA Clinical Liaison...

Novant Health is seeking an RN Coach for telephonic virtual care to help patients navigate their healthcare journey through chronic-care management, self-management support, and acute triage, collaborating with physicians and care teams to deliver...

CVS Health is hiring a Registered Nurse in Utilization Management to apply clinical guidelines and coordinate care decisions. The role supports members by linking them to programs and resources while coordinating with providers and care teams.

Healthcare Management Solutions, LLC is seeking experienced CHSD Audit reviewers to conduct independent medical record reviews for the STS CHSD program. This remote, part-time role focuses on data accuracy, source verification, and adherence to...

Nurse Care Manager We're looking for Nurse Care Managers for our Care and Case Management team, who are passionate about caring for members holistically through their healthcare journey and ensuring needs are met with industry-leading...

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...

Job Title: Clinical RN Job ID: 90637 Location: North Hollywood, California Overview: Are you a dedicated Registered Nurse who excels in outpatient clinical care and thrives in a...

How We Show Up for Our Patients: As a leading provider of outcomes-driven care for individuals and communities living with chronic conditions, Somatus is helping patients across the country enjoy More Healthy Days at...

Job Details: Job Location: Curawest LLC - Denver, CO, Position Type: Full Time, Education Level: High School Diploma or Equivalent, Salary Range: $55000.00 - $60000.00Salary, Travel Percentage: None, Job Shift: Day (First Shift), POSITION PURPOSE:...

TALENT Software Services is seeking a Clinical Quality Reviewer to join our CA-based remote team. You will review PQI allegations and coordinate multi-level reviews, applying clinical judgment to determine escalation paths and final...