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PIH Health Downey Hospital is seeking an RN Case Manager to guide patients from pre-admission through post-discharge, ensuring smooth transitions and appropriate utilization of hospital services.You will focus on maximizing reimbursement from...

Sagility is seeking an RN Trainer (Contract) to support seasonal ramp, delivering classroom and virtual training to new hires and upskilling staff across the US. You will supervise nesting and JIT coaching, ensure client process adherence, and...

Oscar Health is seeking a Utilization Review Nurse to join our team. You will review cases, verify medical records, and consult with care providers to assess treatment appropriateness using Oscar Clinical Guidelines, MCG, and InterQual. The...

Centene Corp. is hiring a Quality Improvement Coordinator II to conduct reviews of delegated entities for quality, service performance and utilization, and to lead clinical quality initiatives across provider sites. The role involves...

The VITAS Telecare RN is a member of the interdisciplinary team who is the pivotal person responsible for identifying the physical, psychological, social, and spiritual needs of those patients and families needing assistance after normal business...

*Job Summary and Responsibilities* As our Clinical Nurse, you will be a central figure in our patient care team, delivering exceptional, compassionate care that truly makes a difference in our patients' lives. Every day you will collaborate...

To support effective utilization management, the part-time Senior Utilization Review Specialist will conduct concurrent and retrospective reviews of hospital services, ensuring compliance with medical necessity and payer authorization while...

Responsibilities: How you'll change lives...

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

Humana is seeking a Telephonic Registered Nurse Care Manager to support patients transitioning into and out of Humana's home-based services. This remote role reports to the Manager, Care Management and focuses on post-acute levels of care,...

Summary We are currently hiring for a Managed Care Coordinator I to join BlueCross BlueShield of South Carolina. In this role as a Managed Care Coordinator I, you will review and evaluate medical or behavioral eligibility...

Job SummaryWorks collaboratively with an MD to coordinate and screen for the appropriateness of admissions and Continued stays. Makes recommendations to the physicians for alternate levels of care when the patient does not meet the medical...

We're building a world of health around every individual - shaping a more connected, convenient and compassionate health experience. At CVS Health®, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold...

Nurse Consultant I (NS) The North Carolina Department of Health and Human Services (DHHS) is one of the largest, most complex agencies in the state, and has approximately 17,000 employees. It is responsible for ensuring the health,...

Overview The Transfer Center RN Specialist is dedicated to facilitating appropriate patient transfers into Carle Hospital from referring physicians and facilities (hospitals, clinics, convenient/urgent cares, surgery centers,...

Job Description: The Registered Nurse (RN) is a professional caregiver who assumes responsibility and accountability for assessing, planning, implementing and evaluating care of patients. The staff RN utilizes the nursing process by use of...

Saint Luke's Hospital of Kansas City in the United States is seeking an experienced Registered Nurse for our Primary Care Shoal Creek location. The role features a Monday through Friday schedule, 8:00 am to 4:30 pm, with no nights, weekends, or...

A healthcare network is seeking a full-time Registered Nurse for Pre-Admission Testing (PAT) to work remotely. The role involves conducting comprehensive pre-operative assessments, coordinating with the medical team, and ensuring patient readiness...

Employment Type: Full time Shift: Night Shift Description: Position Summary: Reviews assigned cases applying specific criteria and payor guidelines and communicates this review to...

iMPROve Health seeks an RN Reviewer (Workers' Compensation Utilization Review) to serve as an independent contractor (1099) performing independent external medical reviews remotely on an ad hoc basis. As a peer reviewer, you will apply your...

A health care organization in Monterey Park is seeking a Case Manager (LVN or RN) to manage patient care effectively. This role involves working collaboratively with medical teams to establish discharge plans and ensure compliance with health...

UnitedHealthcare is seeking a Senior Clinical Admin Nurse RN for Emerging CARE, with remote work flexibility across the United States. The role supports members by providing guidance, education, and front-line clinical resources to manage health...

Find your calling at Mercy! Position Details: Primary Care Nurse RN or LPN Mercy Clinic Primary Care - Quailbrook (OKC) Monday-Friday, 40 hours per week *This is...

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...

About This Role The Case Manager Continuing Care Coordinator RN-Per Diem is responsible for coordinating patient care and managing health conditions for defined patient populations. This role is ideal for a registered nurse with leadership...