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Position Summary Care Navigator will be responsible for case management specific to kidney health management. The Care Navigator will complete activities for the continuum of care to facilitate and promote high quality,...

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...

Clinical Specialist Base Compensation Range $72,000 - $85,000 USD Compensation & Benefits Competitive cash compensation Comprehensive health plans Generous PTO Future focused 401k match...

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...

Workers' Compensation Care Coordinator Carisk Partners, a Best Places to Work award winning organization, is a specialty risk transfer, care-coordination company servicing insurers, government entities, self-insured plan sponsors and...

PRN Assessment Nurse The PRN Assessment Nurse is responsible for identifying current and future patient care needs; being able to recognize normal versus abnormal body physiology. The role requires critical thinking, attention to detail...

PURPOSE: Provide nursing care to patients/families by utilizing the nursing process via the telephone for all patients. $5,000 sign on bonus! ESSENTIAL DUTIES AND RESPONSIBILITIES: Delivers care to patients...

Nurse Case Mgr I Nurse Case Manager I VIRTUAL: This role enables associates to work virtually full-time, except for required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes...

Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the...

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process. Registered Nurse Full Time Service Worker Remote-Pennsylvania, US...

Triage Nurse Case Manager The Triage Nurse Case Manager evaluates workers' compensation injury referrals to determine the appropriate level of medical case management intervention. This role reviews injury details and medical information...

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,...

Centene is seeking a Clinical Review Nurse for a remote role supporting members in Pennsylvania. The candidate will perform concurrent reviews, assess care necessity, and contribute to discharge planning, leveraging case management or utilization...

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...

Resp & Qualifications We are looking for an experienced professional to work remotely from within the greater Baltimore metropolitan area. The incumbent will be expected to come into a CareFirst location periodically for...

Inpatient Nurse Informaticist / Clinical Annotation Specialist 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...

American Health Plans Franklin, TN 37067, USA Description American Health Plans, a division of Franklin, Tennessee-based American Health Partners Inc. owns and operates Institutional Special Needs Plans (I-SNPs) for...

Utilization Management CoordinatorView Behavioral Health LLC Long Beach, California, United StatesAbout this positionWe are proud to serve as a trusted resource for our community, providing high-quality mental health care with compassion and...

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...

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...

Utilization Management Nurse Specialist RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: Full Time Salary Range: $88,854.00 (Min.) - $142,166.00 (Max.) Established 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...

Overview The OP Care Management RN provides care management and population health services to patients. The primary target population served is the stratified risk patient or patients with high vulnerability at times of...

About IntusCare IntusCare is the only end-to-end technology ecosystem built specifically for PACE (Programs of All-Inclusive Care for the Elderly) and similar coordinated care models. We help our customers deliver exceptional...

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,...