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Utilization Management Registered Nurse (UM RN) We're seeking a dedicated and detail-oriented Utilization Management Registered Nurse (UM RN) to join our growing healthcare team. In this role, you'll perform both inpatient and outpatient...

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...

CareHarmony is seeking a licensed practical nurse to join as a remote Intake Coordinator in a full‑time role. The position supports value-based care management by coordinating resources for patients and conducting preliminary health assessments...

Peer Review RN The Peer Review RN is responsible for facilitating the design, implementation and the ongoing evaluation of the physician peer review program and nursing peer review process in collaboration with physician leaders and...

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

Trillium Health Resources is seeking a Compliance Nurse to perform clinical compliance reviews and evaluate claims to ensure adherence to regulatory and coverage requirements. The role applies clinical judgment to assess documentation, determine...

Job Summary and Responsibilities As our RN Care Coordinator is responsible for overseeing the progression of care and discharge planning for identified patients requiring these services. The RN Care Coordinator performs this...

Care Management Team Member The Care Management team independently manages complex and high-risk care management cases by applying advanced clinical judgment to assess medical necessity, develop cost-effective care plans, and support...

Responsible for reviewing medical records and preparing clinical appeals in response to medical necessity denials and diagnosis-related groups (DRG) reassignments Responsibilities Prepare and submit clinical appeals...

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...

Job Title Day to Day Responsibilities Research and design treatment/care plans to promote quality of care, cost-effective health care services based on medical necessity complying with contract for each appropriate plan type.

Your Role The Care Management team independently manages complex and high-risk care management cases by applying advanced clinical judgment to assess medical necessity, develop cost-effective care plans, and support...

Job Title This is a remote, PRN position but will need onsite training in Mishawaka Indiana. Shift: Days - 8 hr shift LOCAL CANDIDATES ONLY! Why Choose Saint Joseph Health System? At Saint Joseph Health System, our values...

Job Title: Utilization Management Registered Nurse (UM RN) – SNF / MLTC Location: Remote (Must reside in NY, NJ, or CT) Schedule: Monday – Friday, 9:00 AM – 5:00...

Medlivo is seeking a travel nurse RN Utilization Review for a travel nursing job in Downey, California. Job Description & Requirements Specialty: Utilization Review Discipline: RN Duration:...

Clinical Nurse Professional Development Educator Advanced How would you like to work in a place where your contributions and ideas are valued? A place where you can serve with compassion, pursue excellence and honor every voice? At...

Primary City/State: Virtual Arizona Category: Case Management Shift: Day Department: Case Management Seeking Applicants That Can Work at Least 8 Shifts per Month Great care starts...

Overview As a patient-focused organization, University of Utah Health exists to enhance the health and well-being of people through patient care, research and education. Success in this mission requires a culture of...

Case Management Support To provide support and facilitate care for members who require case management. To work collaboratively with the Health Plan and Hospital Case Management Departments to facilitate services. To collaborate with the...

Overview Facilitates, in collaboration with the Manager of Quality Management accurate, timely and consistent clinical data to public reporting databases and agencies, including The Joint Commission (Oryx), and CMS.

Job Title: Infusion Registered Nurse (RN) Location: Pasadena, CA (Surrounding areas) Job Type: Per-diem Position Overview We are seeking a skilled and detail-oriented Infusion Registered Nurse (RN) with strong vascular access...

Utilization Management Team Member Responsible for clinical review of utilization requests and assessment and implementation of potential coordination of care opportunities for overall membership, institutionalized populations, high risk...

Medica is a nonprofit health plan with more than a million members that serves communities in Minnesota, Nebraska, Wisconsin, Missouri, and beyond. We deliver personalized health care experiences and partner closely with providers to ensure...

Centene Corporation is seeking an RN- or LPN/LVN-licensed nurse to serve as a liaison for statewide appeals, fair hearings, and external reviews. This remote role supports Eastern and Central time zones with a standard 8–5 schedule and requires...

RN/NP Clinical Quality Reviewer Primary Care, Acute Symptom Triage & Travel Health | Contract, up to 25 hrs/week About the Role We are seeking Nurses & Nurse Practitioners with clinical experience in one or more of the...