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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...

Neolytix is seeking a remote, full-time Clinical Operations reviewer in the United States. The role leverages a nursing background to assess documentation for authorization, utilization review, and payer workflows. You will manage...

Nurse Care Manager The Nurse Care Manager is responsible for providing care coordination including in-home assessment, planning, facilitation, advocacy and authorization of covered plan services to meet the member's health needs while...

Registered Nurse – Care Management (Remote) (Day Schedule) United States Job Title: Registered Nurse – Care Management (Day Schedule) Location: 100% Remote - United States Employment...

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, affordability,...

Description LifeHealth, LLC, a federal government contractor, is seeking Registered Nurses to provide telephonic Nurse Advice Line services to Soldiers, Veterans, Wounded Warriors and their families, who are TRICARE members.

Inland Empire Health Plan in California seeks an LVN-validated Claims Review Nurse to audit medical necessity across inpatient and outpatient claims and support the UM/Claims interface. You will analyze records, determine authorization needs, and...

Job Overview: Pay Range: $46.76hr - $51.76hr Requirement/Must Have: 5+ years Clinical nursing experience. 2+ years Care Management. Bachelor's Degree in Nursing. In...

Parenteral Services Clinical RN Specialist The Parenteral Services Clinical RN Specialist provides clinical support to the Parenteral Services team through advanced nursing expertise, education, care coordination, and operational...

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 health outcomes by connecting people with the care, pharmacy benefits, data...

Case Manager Utilization RNWorks collaboratively with an MD to coordinate and screen for the appropriateness of admissions and continued stays. Makes recommendations to the physicians for alternate levels of care when the patient does not meet the...

CHOICES Case Management, Inc. is seeking an Administrative Assistant to support our Nurse Case Managers in a fast-paced healthcare environment. This role serves as the operational backbone, ensuring details are handled, communication flows...

A virtual health treatment company is seeking a Family Nurse Practitioner to provide care for patients with eating disorders through their telehealth platform. This position requires managing a high patient case-load, conducting assessments, and...

Summary The Registered Nurse-Case management is accountable to the Associate Director for Patient Care Services (ADPCS). Learn more about this agency Duties Help Responsible and accountable...

Company Overview: Join us in our mission to transform healthcare! nirvanaHealth (under RxAdvance Corp.) is committed to bringing the art of the possible to the payer and PBM industries. We invest in our employees at every stage...

AccentCare, Inc. is seeking a Remote Clinical Support Specialist LVN/LPN to support home health teams. You will manage daily KPIs, field staff coordination, verbal orders, and patient documentation while ensuring quality outcomes for patients.

DescriptionJob Summary:Under the general supervision of the CM Director the nurse case manager manages clinical resource utilization and documentation affecting reimbursement, acting as a resource to staff and physicians in resource efficiencies...

Remote — work from anywhere. This is a part-time telehealth role; an active California Nurse Practitioner license is required. About Nolia Health Founded in Seattle, Washington, Nolia is a healthcare company dedicated to providing personalized,...

Administrative Assistant - Cancer Registry (Remote) Healthcare Admin Jobs has an excellent opportunity available within our Administration Department. This is a remote position. If you are looking for challenging work and meaningful...

Piper Companies is seeking a Clinical Appeals Nurse to join a leading health insurance organization for a contract remote opportunity located in North Carolina. The Clinical Appeals Nurse will serve as a clinical...

Overview TEEMA is partnering with a leading organization supporting a large-scale federal healthcare program to identify a Clinical Quality Reviewer. This role focuses on reviewing clinical cases, identifying potential quality or safety...

Nurse Case ManagerUnder the general supervision of the CM Director the nurse case manager manages clinical resource utilization and documentation affecting reimbursement, acting as a resource to staff and physicians in resource efficiencies and...

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...

Clinical Reviewer, Inpatient RN Point32Health is a leading not-for-profit health and well-being organization dedicated to delivering high-quality, affordable healthcare. Serving nearly 2 million members, Point32Health builds on the legacy...

Connect America is seeking a Remote Care Nurse II to deliver high-quality nursing care to patients in a remote setting via telehealth. You will perform remote assessments, develop care plans, and coordinate with a multidisciplinary team to improve...