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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...

Job Description Cedars-Sinai has been named to the Honor Roll for the ninth consecutive year and tied for #1 in California and Los Angeles in U.S. News & World Report's “Best Hospitals 2024-25” rankings, as well as...

Centene Corporation is seeking a remote healthcare professional in Missouri to coordinate care management for members, develop personalized care plans, and educate families on benefits and services. The role supports children with elevated blood...

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...

Utilization Management Nurse Specialist RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: Full Time Requisition ID: 13298 Salary Range:...

Founded in 1977 as the Senior Care Action Network, SCAN began with a simple but radical idea: that older adults deserve to stay healthy and independent. That belief was championed by a group of community activists we still honor today as the "12...

Nurse Advocate Valeris is a fully integrated life sciences commercialization partner that provides comprehensive solutions that span the entire healthcare value chain. Formed by the merger of PharmaCord and Mercalis, Valeris...

Nurse Care Manager - Telephonic (Local Remote) Tandigm Health, a transformational leader in population health management, is looking for a Nurse Care Manager - Telephonic in the greater Philadelphia area. We offer a competitive...

Job OverviewPay Range: $46.76hr - $51.76hrRequirement/Must Have5+ years Clinical nursing experience.2+ years Care Management.Bachelor's Degree in Nursing.In lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required...

Job Title Location: 100% Remote – Any US State Shift: Fri-Sat-Sun-Mon 8:30 am – 6 pm CST Overtime may be required and Holidays are required Duration: 12months Job Profile Summary: Will be working with the IL and MI Medicaid...

LVN Case Manager Under supportive supervision, the LVN Case Manager supports the physician and interdisciplinary team in the provision of patient care, with the underlying objective of enhancing the quality of clinical outcomes and...

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...

Your Role The Utilization Management team independently manages complex utilization and retrospective clinical reviews across multiple lines of business, assessing medical necessity, coding accuracy, treatment plans,...

Salary : $87,954.72 - $112,272.00 Annually Location : Los Angeles County, CA Job Type: Full time Job Number: b9035J Department: MENTAL HEALTH...

ExamWorks is seeking a self-driven RN or LPN to join our team as a Clinical Quality Assurance Coordinator. This 100% remote role supports peer review reports, ensuring high quality, evidence-based rationales, and compliance with client...

Host Healthcare is the #1 ranked travel healthcare company in the U.S. with an immediate option for this RN position in Lynwood, CA. Sign-up here to submit your application for this role or for more information about this role, contact a member of...

Research Nurse (Per Diem) - Greater Portland, OR areaIllingworth Research Group provides a range of patient focused clinical services to the pharmaceutical, healthcare, biotechnology and medical device industries. These include mobile research...

Availity, a leader in healthcare technology, is hiring a UM Nurse Analyst (Clinical Informaticist) to interpret payer medical policies and build AI-enabled decision trees for automated prior authorization. You'll collaborate with Product,...

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...

Job Title Utilization Management Team Leader Job Description The Utilization Management team independently manages complex utilization and retrospective clinical reviews across multiple lines of business, assessing medical...

Registered Nurse Care Coordinator Company: Merrimack Health Work Type: Remote Employment: Temporary Location: US Seniority: Mid Level Technologies: InterQual Requirements: BSN preferred; Massachusetts RN license; minimum 5 years clinical nursing;...

Care Manager, RN Shriners Children's is an organization that respects, supports, and values each other. Named as the 2025 best mid-sized employer by Forbes, we are engaged in providing excellence in patient care, embracing...

Description Under supportive supervision, the LVN Case Manager supports the physician and interdisciplinary team in the provision of patient care, with the underlying objective of enhancing the quality of clinical outcomes...

R1 RCM Inc. is seeking a Clinical Coding Appeals Nurse to review medical records and draft appeals for denied and underpaid claims. The role focuses on accurate coding using ICD-9/10, CPT, HCPCS, and NCCI guidance, and requires inpatient...

Description Research Nurse (Per Diem) - Fort Wayne, IN Illingworth Research Group provides a range of patient focused clinical services to the pharmaceutical, healthcare, biotechnology and medical device industries. These include...