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CVS Health Corporation is seeking a RN-qualified professional to lead quality improvement initiatives and performance measurement within POSC, aiming to meet HEDIS and CAHPS goals. The role involves analyzing clinical workflows, implementing...

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...

Supports the values of service excellence, teamwork, and integrity while managing patient care. Acts as a liaison among patients, caregivers, multidisciplinary teams, and payers. Qualifications: Requires a...

Description Location: UCHealth Anschutz Inpatient Pavilion - Aurora Department: Labor & Delivery Metro Denver Women and Infants (W&I) Float Pool RNs will support patients and teams at Highlands Ranch Hospital, Longs Peak Hospital, and University...

Qlarant, a nonprofit organization, seeks a Nurse Specialist II to perform medical record and claims review for Medicare, Medicaid, and other data. This remote role in the United States involves ensuring adherence to guidelines while assessing for...

Responsibilities: How you'll change lives ...

Location: Orion Building - 6630 Orion Drive Fort Myers FL 33912 Department: Utilization Management - Corporate Work Type: Full Time Shift: Shift 1/7:00:00 AM to 3:30:00 PM Minimum to...

Summary This opening is for a Hiring/Onboarding Event. After qualifications are verified, invited candidates in Los Angeles will attend in person; others may interview virtually. Date: Saturday, November 7, 2026 Time:...

Trinity Health is seeking a Night Shift RN Utilization Review in Grand Rapids, MI, offering full-time work with remote options. You will review assigned cases against criteria and payor guidelines to ensure proper reimbursement and medical...

Molina Healthcare is seeking a Wisconsin-licensed RN for a remote IRIS Self-Directed Personal Care (SDPC) role. You will oversee a group of IRIS participants, assess needs, and educate providers and participants in their homes and communities.

Trillium Health Resources is seeking a Registered Nurse to join our Utilization Management team in North Carolina. The UM reviews, coordinates care, and supports discharge planning to improve outcomes and ensure appropriate utilization of...

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...

Hiring Registered Nurses (RNs) for Skilled Nursing Facility We are seeking compassionate RNs / Registered Nurses to work within our client's facilities, providing follow-through of the physician-established plan of treatment and working...

Humana Inc seeks a Utilization Management Nurse to apply clinical nursing skills in coordinating, documenting, and communicating medical services and determinations. You will interpret criteria, policies, and procedures to provide the best care...

Primary Care Registered Nurse Pittsburgh, PA 15218 Description JOB SUMMARY: The Primary Care Registered Nurse will facilitate the mission of Metro Community Health Center to ensure the delivery of quality patient care and coordination of...

Corewell Health is seeking a Telehealth Registered Nurse to provide remote patient care from the Care Center Breton in Kentwood. You will work evenings with 36 hours per week, delivering patient assessments, education, and follow-up via telehealth...

Prolific is seeking Registered Nurses to train and evaluate AI models. If successful, you'll be invited to join Prolific as a Domain Expert participant, where you'll get paid to train and evaluate powerful AI models. Researchers paying up...

Fully Remote : Clinical Documentation Specialist Job Description Facilitate the improvement of clinical documentation by collaborating with physicians, nursing staff, and other patient caregivers.

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...

Current Saint Francis Employees - Please click HERE to login and apply. Full Time Shift: 10a - 10p Minimum of 5 years bedside experience preferred. Critical Care RN experience required...

Advocate Health is seeking an experienced Registered Nurse for a remote-based Transitional Care role focused on high-risk patients undergoing discharge and 30-day transitions. The role emphasizes comprehensive assessments, patient education, and...

Medix is seeking a fully remote Registered Nurse to perform clinical review and telehealth–style assessments from anywhere in the United States. You will review records, determine next steps, and escalate when needed, while supporting...

Registered Nurse (RN) – Outpatient Clinic Location: San Jose, CA Job Type: Full-Time, Permanent Schedule: 40 Hours per Week Start Dates: Available Every Monday EMR: Epic Join a Patient-Focused Healthcare Team We are...

Overview Our client is a trusted leader in healthcare services, dedicated to improving outcomes for patients and providers through innovative solutions and high-quality care. Join a team committed to making a meaningful difference in the...

Registered Nurse Primary Care Horizon Blue Cross Blue Shield of New Jersey empowers our members to achieve their best health. For over 90 years, we have been New Jersey's health solutions leader driving innovations that improve health...