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MES Solutions is seeking a self-driven RN or LPN to join as Clinical Quality Assurance Coordinator. This 100% remote role focuses on reviewing peer reports, ensuring accuracy, and aligning with client agreements, regulatory standards, and state...

Broadway Ventures, a veteran-owned SDVOSB headquartered in Mississippi, seeks an experienced Registered Nurse to perform medical review of complex claims, pre-authorization requests, appeals, and fraud referrals. You will apply clinical expertise...

St. Louis Children's Hospital is seeking an RN for after-hours triage and nursing support via the Answer Line. The role involves assessing patient needs, guiding care plans, and educating families within established guidelines. Part-time...

Benefits: High Degree of Independence Flexible schedule Elevate Patient Care from the Comfort of Home Are you a highly skilled RN looking for the autonomy of independent practice and the flexibility of a part-time...

Job Summary Collaborates with Education Consultants, Managers, CNS staff and Physicians to develop, design, deliver and evaluate/improve education strategies and special projects/programs based on clients departmental goals and needs, as well as...

Alliance Health is seeking an UM Clinical Specialist RN for Physical Health who works remote with NC-based residency and occasional travel for in-person meetings. The role focuses on medical necessity reviews for inpatient and outpatient services,...

*Job Summary and Responsibilities* As our Registered Nurse (RN), you will be a pivotal healthcare professional, delivering compassionate, high-quality care that truly impacts our patients' well-being and recovery. Every day, you will...

WPS Health Solutions in Columbus, OH, is seeking an Appeals Nurse to review medical records and Medicare claims for first-level appeals to determine medical necessity and coverage alignment. The role collaborates with Appeals Examiners to...

Namely is seeking California Based Nurse Care Managers for remote work to support members through their healthcare journey, ensuring needs are met with leading interventions. The position requires a Bachelor of Science in Nursing, 5+ years...

A healthcare organization is seeking a Texas licensed RN as a Care Manager to oversee care for complex cases. The role involves conducting assessments, developing care plans, and collaborating with a multidisciplinary team. Ideal candidates will...

Remote Nursing OpportunitiesAre you looking for an exciting way to utilize your nursing skills and expertise to deliver quality nursing care in a remote setting? AccessNurse, where technology meets compassionate care, is looking for professional...

A healthcare organization is seeking an RN Case Manager to work remotely and facilitate case management activities, evaluating medical needs for overall member wellness. Candidates should have an active RN license, ideally compact, with at least...

A healthcare management firm is seeking an RN Care Management Coordinator – Compliance Specialist to ensure compliance with relevant regulations and standards. This remote position requires a minimum of five years of clinical experience, an...

Humana Inc. in the United States is seeking a Part C G&A Nurse (Utilization Management Nurse 2) to support case preparation, review medical documentation and coordinate appeal determinations. This remote, full-time role requires an RN with...

TurningPoint Healthcare Solutions is a rapidly growing and innovative healthcare company that supports several large national health plans to improve the quality and affordability of healthcare patients receive. We are looking for motivated...

Qualifications VA Health Professional Trainees (HPT) pending the completion of educational or certification/licensure requirements may be referred and tentatively selected but may not be hired until all requirements are met. A HPT is an individual...

A healthcare quality organization is seeking a Nurse Reviewer to perform comprehensive medical necessity reviews for Medicaid claims. The ideal candidate will have a BSN and an active RN license, along with experience in medical record review.

SCAN Group is seeking a remote RN to enhance frail seniors' ability to age in place by delivering person-centered care via telephonic care coordination. You will develop and implement plans of care, educate members, and coach them to manage...

Cedars-Sinai is seeking an experienced Registered Nurse to advocate for patients with diabetes before and during pregnancy. This very independent part-time role will allow some work from home. The CDE will see patients in-clinic and maintain a...

A healthcare auditing firm is seeking a Hospital Bill Audit Nurse Supervisor to lead a remote team responsible for hospital bill audits. The candidate should have a nursing background with at least 5 years of experience in acute settings and be...

Qualifications VA Health Professional Trainees (HPT) pending the completion of educational or certification/licensure requirements may be referred and tentatively selected but may not be hired until all requirements are met. A HPT is an individual...

A leading staffing agency is looking for a Utilization Review Registered Nurse to work remotely with a major health insurance client. This role involves evaluating patient care cases and ensuring requested services align with medical necessity...

Gainwell Technologies is seeking a Medical Reviewer (Registered Nurse) to support California healthcare programs. You will use clinical judgment to review medical records, healthcare services, claims, and authorization requests. You will...

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 regulations...

Kaiser Permanente is seeking a registered nurse with utilization management experience to oversee skilled and custodial patient care in rehabilitation SNFs. The role focuses on benefits checks, discharge management, and coordinating a chronic...