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Clinical Appeals Nurse We are seeking an experienced Clinical Appeals Nurse to support the appeal and grievance processes by analyzing and responding to adverse coverage decisions. This role involves clinical judgment, regulatory...

Supervisor Utilization Management The Supervisor Utilization Management is responsible for the direct supervision of the daily operations of the Centralized Utilization Management department in order to assure that utilization management...

Job Title: Clinical RN Job ID: 90637 Location: North Hollywood, California Overview: Are you a dedicated Registered Nurse who excels in outpatient clinical care and thrives in a...

Enlyte in Downey, CA is seeking a Field Case Manager (RN) to lead workers' compensation case plans, coordinating with physicians, employers, and patients to ensure effective and timely recovery and return-to-work.The ideal candidate has 2+ years...

JOB REQUIREMENTS: -Experience: 3 years acute care case manager experience -CA RN License -Certs: BLS -**FLU VACCINE (no exemptions)** Flu season starts September -Special Requirements: EPIC highly preferred. Due to nature of...

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...

Life in Long Beach is So Much Sweeter Long Beach is a waterfront playground located right in the heart of Southern California. Here you can experience it all: a deep-sea adventure at the Aquarium of the Pacific, whale watching on the...

Job Summary and Responsibilities As our RN Care Coordinator, you will be a central figure in patient care, seamlessly navigating the healthcare journey to achieve optimal outcomes and an exceptional patient...

Payrate: $41.00 - $43.00/hr Summary: The main function of the nurse is to provide and coordinate patient care, educate patients and the public about various health conditions, and provide advice and...

The Department of Family Medicine of the Keck School of Medicine of USC provides care for every member of the family, across generations and over lifetimes. We aim to enhance the quality of life for underserved and vulnerable patients while...

Case Management SupervisorThe Case Management Supervisor assists the Director with the overall development of the case management program and implements at the hospitals. This includes oversight of all case management staff, development and...

Nurse Practitioner (NP) – PRN Location: LifeSpring Recovery Center – Andover, Kansas Status: PRN (10 hours per week) - Mostly Remote may need to be on site from time to time. Available to rotate on call -1-2 weeks per...

Care Coordinator/LPNEmpassion is one of the most impactful and exciting start ups in health care. We are focused on improving the experience and lowering costs for seniors at end of life. Specifically, we provide palliative and hospice care for...

LeaderStat is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in Torrance, California. Job Description & Requirements Specialty: Utilization Review Discipline: RN...

Are you in search of a fulfilling and meaningful position? Do you want to work for an organization that promotes growth and development? Here at Men's Health Foundation we envision a world where inequity and stigma do...

Integra Partners is seeking an LPN/LVN with managed care UM experience to perform pre-service and post-service utilization reviews and appeals for DMEPOS in a NCQA-compliant UM program. The UM Nurse will collaborate with the Medical...

Secondary Review Nurse At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better.

Inpatient Precertification Contractor Our contractors are work from home and not required to come on site. Perform prospective, concurrent and retrospective review of inpatient, outpatient, ambulatory and ancillary services to ensure...

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...

Registered Nurse-Review Analyst Our client, a Health Insurance company, is looking for a Registered Nurse-Review Analyst for their remote location. Responsibilities: Perform prospective, concurrent, and retrospective...

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...

Overview Essen Health Care is the largest privately held, multispecialty medical group in New York, providing high-quality, compassionate care to some of the state's most vulnerable and underserved residents. Founded in 1999, we've...

Employment Type: Full time. Shift: Day Shift. Description: Purpose Work Remote Position The Nursing Support (NS) colleague (uncertified, certified, unlicensed, or licensed) provides safe, quality health care services & / or...

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...

CVS Health is seeking a Nurse Consultant for Utilization Management in a 100% remote capacity. The role reviews inpatient and outpatient services using evidence-based criteria, authorizes care with providers, and escalates cases as needed.