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HonorHealth is seeking an experienced Utilization Review RN Specialist for a remote-capable role serving the greater Phoenix area. The position focuses on reviewing medical necessity and coordinating reviews for diverse payers, ensuring...

To support client care authorization processes, the part-time Temp Clinical Letter Writer will gather and review medical records, draft letters of medical necessity, and communicate with team members regarding client authorizations and...

UnitedHealth Group is seeking a SSBV Clinical Claims Review RN for a remote role nationwide. You will perform administrative reviews of inpatient hospital claims, document determinations, and ensure accurate use of screening criteria to support...

Baptist in Meridian, MS seeks a Specialist-Clinical Documentation III RN to evaluate day-to-day documentation practices and advise the clinical team on accurate diagnoses and coding. The role requires five years of acute care experience,...

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...

Sentara Health Plans seeks an RN Clinician to perform utilization management and claim reviews across inpatient and outpatient settings. The role supports pre/post payment reviews and authorization assessments, ensuring compliance with policy and...

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...

Sedgwick is seeking a Telephonic Case Manager to join our team as a US-based remote, full-time role. You will collaborate with injured workers, employers, and medical providers to develop case management strategies that promote medical recovery...

Baptist Health is seeking a remote Clinical Documentation Specialist to evaluate physician documentation and ensure accurate illness severity portrayal for coding precision. The role requires an active Kentucky license and involves guiding...

A healthcare staffing company in Torrance, CA is seeking a Senior Healthcare Recruiter for a remote RN position. The ideal candidate will have at least 1 year of Home Health experience and must possess an active CA RN License. Responsibilities...

ExamWorks is seeking a self-driven RN or LPN to join as Clinical Quality Assurance Coordinator. This 100% remote role focuses on QA of peer review reports, ensuring accuracy, clinical citations, and adherence to client specifications and...

Elevance Health is seeking an experienced nurse to review complex cases for medical necessity, applying clinical guidelines and nursing judgment. The role involves collaboration with physicians, case managers, and Medical Directors to optimize...

Nursing Attendant On Call Days (P)Under the direct supervision of a Registered Nurse or physician, performs a variety of patient care functions as assigned and in accordance with the legal scope of competency and within established standards of...

NTT DATA is seeking a BPO Clinical Review Specialist in the United States, with remote work available for Florida residents. The role requires an active RN license (Florida or Compact) and at least 3 years of appeals, utilization management, or...

Managed Medical Review Organization is seeking a skilled registered nurse for a remote, home-office role. The position emphasizes telephonic/customer service, accurate documentation, and clinical review duties without face-to-face patient contact.

Oregon Department of Corrections is seeking an experienced Institution Registered Nurse for a limited-duration role based in Salem, OR, with remote work options. The RN will review medical records, assess care adequacy, and coordinate services...

Job Title: Nurse, Clinical Medical Review Location: Columbia, MD (Primarily remote, but hybrid) Duration: 6 Months Contract PURPOSE: We are seeking a qualified RN or LPN with experience supporting HEDIS reporting and abstraction processes in a...

TEKsystems is seeking a Clinical Quality Assurance Specialist (RN/LPN) for a 100% remote, full-time role with hourly pay of $26.50–$28.50. Training will be conducted on a set schedule, with four 10-hour shifts and potential conversion to 4-day...

CVS Health is seeking an RN for utilization management, coordinating care and determining coverage for members. The role requires clinical judgment, strong communication with providers, and the ability to work in a fast-paced setting. The...

When you join the growing BILH team, you're not just taking a job, you're making a difference in people's lives. Schedule This is a per diem, fully remote opportunity offering flexibility and work-life balance. Minimum commitment of 16 hours per...

Memorial Hermann Health System is seeking a Clinical Documentation & Integrity Specialist for a remote role in Texas. The RN must hold a BSN or MSN and have at least five years of inpatient acute care experience, with ICU exposure preferred.

LanceSoft is seeking a travel nurse RN Clinic for a travel nursing job in Glendale, California. Job Description & RequirementsSpecialty: ClinicDiscipline:...

Ethos Risk Services is seeking a full-time Clinical Recruiter (REMOTE) to lead hiring for the Case Management division. You will own full-cycle recruiting for nurse case managers and other clinical pros, from posting to onboarding, ensuring a...

Essential Duties and Responsibilities: Review requests for services including admission, discharges and continued stays for adherence to clinical criteria, state and federal policy, and related requirements. Issue...

Lana'i Community Health Center is seeking a Clinical Support Registered Nurse (RN) to provide administrative and clinical support to medical providers, enhancing workflow and patient care. The role primarily involves remote support with occasional...