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Alignment Health invites experienced Registered Nurses to join as Telephonic Case Managers for our Special Needs Plan (SNP) members, working fully remotely from anywhere in the U.S. You will navigate care journeys, close gaps in care, and help...

Join Silverado Hospice LA Silverado Hospice LA covering our Torrance and surrounding areas and be part of a nationally recognized team ranked in the top 10 nationwide by Fortune Magazine's Best Workplaces in Aging Services™. Since 1997,...

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...

RN Case Manager | Registered Nurse Hardwick, MN $71,589 - $93,099 a year Full Time Job Summary: The RN Case Manager plays a vital role in promoting optimal social and emotional functioning while helping patients effectively...

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...

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,...

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...

Are You Ready to lead in Healthcare? We are currently seeking a Full-Time Case Manager(LPN/LVN) to join our outstanding healthcare team!Salary Range: $83,203-$93,936 per yearWe are passionate about providing high-quality care and fostering a...

Description Patient Business Services Provide clinical review, audit, analytical, and quality improvement support for utilization management, medical necessity determinations, and denial prevention...

JOB DESCRIPTION Job Summary Work Location: California - Ability to work remote, but selected candidate must reside in the state of California. This position requires California RN Licensure. Candidates must...

Job Profile Summary Position Purpose: Analyzes all prior authorization requests to determine medical necessity of service and appropriate level of care in accordance with national standards, contractual requirements, and a member's...

Utilization Review Specialist (RN) – Work From Home (Florida-Based Candidates Only)Concierge Home Care | Work From Home Opportunity – Must Reside in Florida At Concierge Home Care, we are growing and looking for an experienced...

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...

Clinical Appeals Nurse (RN) | Remote | Contract Walker Healthforce is seeking a Clinical Appeals Nurse (RN) with 2+ years of clinical nursing experience to provide clinical review and...

RN Care Coordinator Care Coordination Inspired by faith. Driven by innovation. Powered by humankindness. CommonSpirit Health is building a healthier future for all through its integrated health services. As one of the nation's largest...

RN Care Management Horizon Blue Cross Blue Shield of New Jersey empowers our members to achieve their best health. For over 90 years, we have been New Jersey's health solutions leader driving innovations that improve health care quality,...

Job Title Case Management Nurse Job Description Centered in the heart of Boyle Heights, Adventist Health White Memorial is one of the area's leading healthcare providers since 1913. We are comprised of a 353-bed hospital,...

After Hours Service Answer Line Rn The Answer Line After Hours Service provides after-hours exchange and nurse triage services for over 300 subscribing community pediatricians in the St. Louis and surrounding areas. Answer Line RNs...

Renown Health is seeking a Utilization Management RN to apply medical necessity criteria for prospective and concurrent reviews. You will work with an interdisciplinary team to ensure medically necessary, cost-effective care at the appropriate...

OverviewJobs for Humanity is partnering with CEDARS‑SINAI to build an inclusive and just employment ecosystem. We prioritize individuals from diverse communities including Refugee, Neurodivergent, Single Parent, Blind or Low Vision, Deaf or Hard...

Utilization Review RN - Remote This position is Per Diem and will work 8-hour, Day shifts. Provide prospective, retrospective, and concurrent utilization reviews for our Southern CA ministries. Conduct clinical reviews and review...

BlueCross BlueShield of South Carolina is hiring a Managed Care Coordinator II - Utilization Management. The role reviews clinical criteria to determine medical necessity and coordinates care management for members. The position is full...

Clinical Clearance Specialist (RN) Remote, United States Why Charlie Health? Millions of people across the country are navigating mental health conditions, substance use disorders, and eating disorders, but too often,...

Utilization Management Registered Nurse (RN) - Remote Full-time WHO IS GUIDEHEALTH? Guidehealthis a data-powered, performance-driven healthcare company dedicated to operational excellence. Our goal is to make...

Providence California Regional Services seeks an RN Care Manager for a remote, full-time role. The position supports patient-centered care management and appeals coordination, focusing on reimbursement for services in the PH&S network.