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An established healthcare provider in California seeks a Clinical Quality Assurance Nurse to ensure the accuracy of reviews and compliance with policies. The role involves overseeing quality assurance processes, conducting peer reviews, and...

Summary Greater Los Angeles Healthcare System (GLVAHCS) is seeking 1 highly skilled experienced Registered Nurse (RN) for our West Los Angeles Primary Care Unit. Located in Los Angeles, CA. Responsibilities Primary care service. The Nurse I, Level...

* Position is Eligible for Remote / Work from Home Opportunity * Department: DME Appeals Job Grade: E11 As a condition of employment physical work location must be in one of the 50...

Quality Assurance Nurse The Quality Assurance Nurse is responsible for case management quality assurance and mentorship of operations staff, providing tools and calibrating processes, while ensuring consistent delivery of CorVel's case...

Field Based Nurse Case Manager – RN OHARA, LLC has an opening for a full-time Field Based Nurse Case Manager in the Iowa City, IA area. We are driven to facilitate prompt delivery of quality, cost-effective health care to injured...

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...

Mentor Community Services,a part of the Sevita family, provides community-based services for individuals with intellectual and developmental disabilities. Here we believe every person...

Your job is more than a job RN Care Manager - PRN - Remote You overthink every care option and scenario because, as a Care Manager, you're the hub of your patient's case management and care plan. You assure quality through...

PURPOSE OF THIS POSITION The Registration/Medical Records Clerk is responsible for patient registration, secretarial and clerical duties in the surgical center and maintaining the center's medical records according to established guidelines and...

Schedule: The position is 100% Remote, and the candidates must reside in Southern Californi Description: The Grievance & Appeals Nurse is responsible for managing and coordinating member grievance and...

Description Work Schedule: Full Time, 80.00 hours per pay period (2 weeks) Shift: Days Pay: $40.86 - $63.33 / hour. Pay is dependent on applicant's relevant experience This position is an onsite role and does not offer a hybrid or remote option...

Denials Case Manager, RN The Denials Case Manager, RN appeals all denials using InterQual criteria and medical necessity. Collaboratively works with all members of the revenue cycle team and all types of payers to resolve denials,...

Company: Providence at Home with Compassus Position Summary The Clinical Liaison serves as the primary connection between Providence hospital facilities, Compassus Providence Joint Venture (JV) Agencies, and...

Job Title Provides, coordinates, teaches, and supervises nursing care for a group of patients in the setting of the patients' home. Employs the nursing process to develop and implement plans of care for patients requiring in-home...

Clinical Nurse Navigator (RN) Compensation: $80,000 - $85,000 annual salary, plus annual potential for bonus and merit increases Employment Type: Full-Time, Salaried, Exempt Reports to: Director of Oncology and Infusion...

Wellness Nurse Consultant Wellness Nurse Consultant Field: This field-based role enables associates to primarily operate in the field, traveling to client sites or designated locations as their role requires, with occasional office...

Evolve Adolescent Behavioral Health in Los Angeles is seeking a full-time nurse to provide care for teens aged 12 to 17. Responsibilities include direct patient care, triage medical concerns, and medication management. The position demands a valid...

Position SummaryThe Manager of Care Management will supervise and direct all levels of the Care Management team that includes RN Care Managers, Lead Care Management RN, Care Management Coordinators, Discharge Planners (DCP), Care Coordinators, and...

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,...

Are you ready to bring your clinical competencies to a world‑class Medical Group known for the very highest clinical standards? Do you have a passion for the highest quality and patient satisfaction? Then please respond to this dynamic...

A healthcare organization based in Los Angeles is seeking a skilled professional to provide vital support for discharge planning within the Continuum of Care Team. This role involves collaboration with Case Managers and Social Workers to ensure...

External Case Manager - Inpatient Rehab (RN, PT, OT, SLP)Cal Rehab, a joint venture with Select Medical, UCLA, and Cedars SinaiFull‑time (Mon‑Fri 8 am‑5 pm, plus rotating weekends) in Los Angeles, CA.Base salary $80,000–$115,000...

OverviewPosition Type: Full timeJob Title: Care Review Clinician ILocation: 100% Remote (Must reside in one of the following states: NV, AZ, FL, GA, ID, IA, KY, MI, NE, NM, NY (outside greater-NYC), OH, TX, UT, WA (outside greater-Seattle),...

Utilization Review Nurse The Utilization Review Nurse will evaluate medical records to determine medical necessity by applying clinical acumen and the appropriate application of policies and guidelines to urgent and standard reviews. You...

Job Description Job Description Date posted: March 9, 2026 Pay: $62,000.00 - $65,000.00 per year Job description: POSITION SUMMARY: Perform duties that require knowledge, skills, and abilities as a licensed professional Nurse (LPN). Assists the...