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Providing timely and evidence-based utilization review services, the full-time Utilization Review RN will work remotely to manage complex medical conditions, treatment planning, and recovery for injured employees while advocating for effective...

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...

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...

Utilization Review Nurse - RN | 100% Remote | Part-Time 10-20 Hours Per Week | Flexible Schedule | Evenings & Weekends Looking for a way to use your nursing experience without returning to a full-time bedside...

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 (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,...

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 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...

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...

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...

Santa Barbara Cottage Hospital is seeking an experienced RN/LPN to perform remote clinical reviews for appeal cases. You will review medical records, apply InterQual criteria, and prepare clinical determinations for physician review. The...

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...

Registered Nurse - Case Management - Travel | Torrance, California Estimated Weekly Pay: $1935.10 Start Date: 10/26/2026 | Duration: 13 Weeks Shift: 5 x...

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...

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...

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

Ampcus Inc. is a certified global provider of a broad range of Technology and Business consulting services. We are in search of a highly motivated candidate to join our talented Team. Job Title: Nurse 3 Job Location: Redondo...

RN Peer Review Analyst, Quality Review, Full Time, Days 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...

Grow Healthy 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,...

Vynca Inc. in Los Angeles County, CA, is seeking an exceptional LVN Case Manager to join our Enhanced Care Management team. This hybrid role offices and field visits, coordinating care among doctors, social services, and families to promote...

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 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...

CVS Health is seeking a Nurse Consultant for Utilization Management in a 100% remote role. You will apply clinical judgment and evidence-based criteria to review inpatient and outpatient services, collaborate with providers to authorize care, and...

Concurrent Utilization Review (UR) Nurse NeueHealth is a value-driven healthcare company grounded in the belief that all health consumers are entitled to high-quality, coordinated care. By uniquely aligning the interests of health...

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...