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POSITION SUMMARY The Clinical Staff Nurse is a skilled and experienced professional Registered Nurse (RN) responsible for excellence in the clinical practice of nursing and the management of patient care. Reporting to the...

CVS Health is seeking a Registered Nurse (RN) to support 24/7 Utilization Management operations in a remote capacity. You will review cases, assess medical necessity, coordinate care, and ensure members receive high-quality healthcare services.

Emory Healthcare seeks an experienced Telehealth Registered Nurse to deliver high-quality remote patient care via telehealth platforms. The RN will assess, triage, educate, and support patients with expertise in clinical algorithms and EMR...

Clinical Registered Nurse (RN) – Remote Full-Time | Remote | $100,000 + Comprehensive Benefits Package We are recruiting RNs for a growing, technology-enabled healthcare organization, expanding its remote clinical...

Job Summary: As the leader of the health care team, provides professional nursing care, utilizing the nursing process in accordance with established standards of care, policies, and procedures. Demonstrates performance consistent...

Remote Care Manager (RN) - MUST LIVE IN TEXAS TX, United States Trending Job Description JOB DESCRIPTION We are searching for six TX licensed RNs to work telephonically with our Medicaid members across the state.

Sentara Health Plans is seeking a Clinical Claims Reviewer/RN for a remote role. This full-time, 40-hour position offers remote work across multiple states and requires RN licensure, BSN, and CPC certification within a year. The role focuses on...

Parkland Health is seeking a Licensed Vocational Nurse (LVN) to provide total nursing care for assigned patients under the supervision of a Registered Nurse. The role requires graduation from an accredited LVN program and current Texas LVN...

Cambia Health Solutions is seeking a dedicated Utilization Management Nurse to perform prospective, concurrent, and retrospective reviews, ensuring medical necessity and cost-effective care. You will collaborate with interdisciplinary teams,...

Arkansas Blue Cross and Blue Shield is seeking an Utilization Management Nurse to perform clinical reviews for prior approvals, network exceptions, and benefit inquiries. The role ensures medical necessity and promotes quality care with cost...

Beth Israel Lahey Health Primary Care is seeking an experienced Transitional Care Nurse to support care coordination for primary care patients. The role is primarily remote with initial onsite training in the North Shore area, focusing on safe...

Job Title: Registered Nurse (Navy Nurse Corps) Category / Component: Officer • Both Overview Navy Nurse Corps Officers deliver professional nursing care to service members, families, and global communities in leading edge military medical centers,...

Mercy is seeking an experienced Registered Nurse for the Virtual triage (vAcute) program in the United States. The role involves 24/7 ED handoffs, scheduling facilitation, and supporting patients in the intensive care coordination pathway across...

Job ID: 33022 Description Take on a key role within an award-winning health system. Help improve patient experiences as part of a world-class healthcare team. Take your career in an exciting new direction. You can...

NurseRemotely is seeking a licensed RN for a remote case management role with a Health Insurance client. You will design care plans, assess needs and coordinate services across various teams to ensure quality, cost-effective care.

Effizotech is looking for a dedicated Patient Care Coordinator to join their team. This role involves coordinating patient appointments for infusion services while ensuring timely communication with patients. The opportunity offers the flexibility...

Ssbv Clinical Claims Review RnOptum 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...

CVS Health is seeking a Transition of Care Case Manager (RN) in Illinois for fully remote work. You'll coordinate post‑discharge plans, ensure medication management, and lead interdisciplinary teams to support high‑risk members transitioning...

Description: FAMILY NURSE PRACTITIONER JOB SUMMARY Provides continuous and comprehensive services necessary for the promotion of optimal health, prevention and treatment, in an underserved community clinic. To perform a variety of advanced clinical...

Knowtion Health seeks an Appeals Nurse to review medical records and support denials appeals for Medicare, Medicaid, and other payers. You will craft detailed analyses and letters, aligning criteria with payer policies to secure appropriate...

A leading virtual care organization is seeking a Work-From-Home Nurse Practitioner to support its telehealth services. This role offers a flexible schedule and the opportunity to provide virtual care assessments for various acute issues. Qualified...

Review claims files to detect potentially fraudulent billing practices.Use medical terminology and coding to assess payment appropriateness.Write investigative summary reports and provide expert testimony.Requirements:Active RN license and 2+...

WellSense Health Plan in Massachusetts is seeking a Remote Prior Authorization Clinician to review hospitalization and outpatient services for medical necessity using InterQual guidelines, ensuring timely and appropriate care for members. This...

About This Role The Care Manager (RN) will support Michigan Medicaid members with complex medical needs through telephonic outreach, health assessments, and care plan development. This role is ideal for those with experience in case...

UnitedHealth Group is seeking a Secondary Review Nurse to evaluate HCBS and Medicaid requests, ensuring medical necessity, cost-effectiveness, and alignment with member service plans. This remote role is open to Indiana residents and offers...