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Description The Peer Review RN is responsible for facilitating the design, implementation and the ongoing evaluation of the physician peer review program and nursing peer review process in collaboration with physician...

Medical Management And Health Education Program Coordinator Fully Remote JOB PURPOSE: This position is responsible for conducting medical management and health education programs for customers on government health care programs.

Overview HarmonyCares is a leading national value-based provider of in-home primary care services for people with complex healthcare needs. Headquartered out of Troy, Michigan, HarmonyCares operates home-based primary care...

Clinical Research Nurse-BSN Clinical Research Nurse Join the transformative team at City of Hope, where we're changing lives and making a real difference in the fight against cancer, diabetes, and other life-threatening illnesses. City of...

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...

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...

Qlarant is a not-for-profit corporation that partners with public and private sectors to create high quality, safe, and efficient delivery of health care and human services programs. We have multiple lines of business including population health,...

The Utilization Management Nurse Reviewer plays a crucial role in healthcare systems by ensuring that medical services are used efficiently and appropriately. They review medical records, treatment plans, and patient information to determine the...

Grievance & Appeals Nurse, RN Find joy in serving others with IEHP! We welcome you to join us in "healing and inspiring the human spirit" and to pivot from a "job" opportunity to an authentic experience! Reporting to the...

Overview Facilitates, in collaboration with the Manager of Quality Management accurate, timely and consistent clinical data to public reporting databases and agencies, including The Joint Commission (Oryx), and CMS.

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...

Compensation: $85,000 – $92,000 Hourly Equivalent: ~$41–$44/hr Location: Remote Schedule: Must work AZ hours (typically 1st shift) CLIENT NOTES / EXPECTATIONS Candidates must meet required AND preferred...

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...

Clinical Specialist Utilization Management Under the general supervision of the Director of Utilization Management for the Detroit Wayne Integrated Health Network (DWIHN), Clinical Specialists – Utilization Management are responsible...

PIH Health in Los Angeles is seeking an RN Peer Review Analyst responsible for retrospective medical record reviews, data compilation to validate quality and accuracy of documentation, and auditing charts for admission/continued stay. You will...

Care Management Team Member The Care Management team independently manages complex and high-risk care management cases by applying advanced clinical judgment to assess medical necessity, develop cost-effective care plans, and support...

Sensorum Health Patient Monitoring and Triage Nurse Job Description ABOUT SENSORUM HEALTH Sensorum Health (sensorum.ai) enables better proactive and preventative healthcare for older adults living at-home.

Chronic Care Coordinator Location: MICHIGAN - 100% REMOTE (NOT A COMPACT STATE) Join our mission to help transform healthcare delivery from reactive, episodic care to proactively managed patient care that prevents live-changing...

Get AI-powered advice on this job and more exclusive features. This range is provided by The Judge Group. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more. Base pay range...

Job Title: Clinical Quality Assurance Nurse Pay: see below Registered Nurse - $28.50/hr (Non-negotiable) LPN/LVN- $26.50/hr (non-negotiable) Regular Schedule after...

Hospice Admissions Nurse Peoples Health Services is the only family-owned, locally governed Hospice and Home Health provider in the Florida Panhandle. We believe that when we take care of the people who care for our patients, everyone...

Medical Solutions is seeking a local contract nurse RN Case Management for a local contract nursing job in Paramount, California. Job Description & Requirements Specialty: Case Management Discipline: RN...

Overview As a patient-focused organization, University of Utah Health exists to enhance the health and well-being of people through patient care, research and education. Success in this mission requires a culture of...

This is a remote role. CircleLink Health is looking for passionate, tech savvy registered nurses to work remotely and serve patients enrolled in Medicare's Chronic Care Management Program. In this part time role...

Centene is seeking an RN with strong appeal review experience to act as liaison for statewide appeals, fair hearings, and review organizations. This fully remote role supports members and providers while ensuring compliance with State and NCQA...