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A healthcare solutions company is seeking a Clinical Review RN (Independent Dispute Resolution) to provide remote case determinations for Independent Dispute Resolution. This role requires a licensed RN in New York State with a minimum of two...

Overview The Patient Clinical Services team is a centralized nursing service where the Patient Clinical Services RN implements best practices in patient care and coordination for participating Primary Care locations by...

Join Martin's Point Health Care - an innovative, not-for-profit health care organization offering care and coverage to the people of Maine and beyond. As a joined force of "people caring for people," Martin's Point employees are on a mission to...

Resp & Qualifications PURPOSE: The Clinical Appeals Nurse completes research, basic analysis, and evaluation of member and provider disputes regarding adverse and adverse coverage decisions. The...

Responsibilities RESPONSIBLE FOR: The purpose of this position is to ensure that acute hospital admission have the appropriate level of care, patient status, plan of care and meet medical necessity for an acute...

Facility: CoxHealth South: 3801 S National Ave, Springfield, Missouri, United States of America, 65807 Department: 1651 Virtual Care Command Center Scheduled Weekly Hours: 24 Hours:...

A leading technology services firm is seeking a Quality Assurance Registered Nurse for a 100% remote contract-to-hire position based in Atlanta, GA. The role entails performing quality assurance reviews, ensuring compliance with clinical...

A leading healthcare provider is seeking a Clinic Registered Nurse (RN) for their urology team in Omaha, Nebraska. This hybrid role allows for remote work after training. The RN will collaborate with a multidisciplinary team to provide...

Description Location: UCHealth Anschutz Inpatient Pavilion - Aurora Department: Virtual Health Center - Quality program This position is an onsite role and does not offer a hybrid or remote...

Overview The challenges of affordable healthcare continue to create new opportunities. Elderplan and HomeFirst, our Medicare and Medicaid managed care health plans, are outstanding examples of how we are expanding services in...

Overview What you can expect! 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...

divh2RN Care Review Clinician/h2pThe RN Care Review Clinician provides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and align with established clinical...

$40/hour - Contract for 6 months Must reside in TX Full time remote Candidates must be based in TX. RN working in the insurance or managed care industry using medically accepted criteria to validate the medical...

Location: Avera Medical Group Pulmonary & Sleep Medicine-Sioux Falls Worker Type: Regular Work Shift: Pay Range: The pay range for this position is listed below. Actual pay rate...

Registered Nurse, Quality Assurance Reviewer The Registered Nurse, Quality Assurance Reviewer will work in conjunction with the Quality Manager and will be responsible for completing quality reviews for the Clinical Services and Provider...

Job Description Medical Edge Recruitment has an immediate opening for an RN (Registered Nurse) for a 24 week contract at a facility in St. Louis, MO. Details: Specialty: Psychiatric...

divh2Job Summary/h2pThe RN Care Review Clinician provides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance...

A major healthcare provider seeks a Transitions of Care RN to deliver patient education across programs for chronic disease management. This role involves conducting assessments, coordinating health-coaching plans, and monitoring the effectiveness...

Job Description RN Utilization Review at Irvine, CA. This position is Part- time and will work Remote 8-hour, Day shifts. Provide prospective, retrospective, and concurrent utilization reviews for our Southern...

Job Description: • Participates in the development and ongoing implementation of QM Work Plan activities. • Improve quality products and services, by using measurement and analysis to process, evaluate and make recommendations to meet...

Discover. Achieve. Succeed. #BeHere Location: US:WI:MENOMONEE FALLS at our CP-NORTH HILLS HEALTH CENTER facility. This job is ON - SITE. FTE: 0.001000 Standard...

Job Summary The RN Utilization Management Care Review Clinician plays a vital role in supporting clinical member services by assessing the necessity and appropriateness of care based on established guidelines and regulations. You...

RN Care Review Clinician The RN Care Review Clinician provides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and align with established clinical...

We are more than a health system. We are a belief system. We believe wellness and sickness are both part of a lifelong partnership, and that everyone could use an expert guide. We work hard, care deeply and reach further to help people uncover...

Description Location: UCHealth UCHlth Anschutz Outpt Pavilion, US:CO:Aurora Department: Preprocedure Services Work Schedule: Full Time, 80.00 hours per pay period (2 weeks) Shift: Days Pay: $32.01 - $49.62 / hour. Pay is dependent on applicant's...