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Sedgwick is seeking a Utilization Review RN for a telecommuter role in Michigan. You will review treatment plans, analyze medical records, and determine appropriate care using evidence-based criteria within a collaborative environment.

About the Role Mercor is hiring experienced Nurse Practitioners to help evaluate and improve cutting-edge AI systems. In this role, you'll evaluate AI-generated clinical content and workflows, leveraging your real-world expertise in...

HonorHealth is seeking an Utilization Review RN Specialist to review and monitor the utilization of health care services, ensuring medical necessity and appropriate levels of care. You will coordinate reviews for Medicare, AHCCCS, self-pay, and...

POSITION SUMMARY Reporting to the Director, Ambulatory Services of Martin Luther King, Jr. Los Angeles (MLK-LA) Healthcare Corporation, the Ambulatory Clinical RN as the leader of the health care team, provides professional...

Exceptional care starts with exceptional people. For us, this is more than a job– it's a calling. It's waking up each day, looking for ways to make a difference with a compassionate, inclusive and talented team. Ochsner empowers...

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...

Optum NV is seeking an RN Case Manager Telephone Advice Nurse to join our team in Las Vegas, NV. Optum is a clinician-led care organization that is changing the way clinicians work and live. As a member of the Optum Care Delivery team, you'll...

Essentia Health in Duluth, MN is hiring for a Health Services professional to conduct Managed Care Programs in coordination with third party administrators. You will help implement referral, prior authorization, and precertification processes...

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Providence Tarzana Medical Center in Tarzana, CA is seeking a Certified Nursing Assistant for the Cardiovascular Unit. This Full-Time role requires CA Nursing Assistant Certification, BLS, and completion of the Nursing Assistant course, with...

Molina Healthcare is hiring a remote RN Care Manager. Preference for candidates in Washington State. This role will be working Pacific Standard Time hours. This role supports Medicare members through telephonic case management and...

Job OverviewPay Range: $46.76hr - $51.76hrRequirement/Must Have5+ years Clinical nursing experience.2+ years Care Management.Bachelor's Degree in Nursing.In lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required...

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.

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...

As a Clinical Documentation Review Specialist (RN), you will help medical staff clarify patient records to ensure appropriate reimbursement and reflect care complexity. You will perform concurrent reviews and engage with physicians...

Allegheny Health Network is seeking an RN Clinical Document Specialist to support remote work from Pennsylvania within 50 miles of Pittsburgh or Erie. The role focuses on improving documentation accuracy to optimize reimbursement, with extensive...

About This Role The Preservice Review RN position at UnitedHealth Group involves assessing customer needs, identifying solutions to complex issues, and conducting clinical research to support medical determinations. This role is ideal for...

Clinical Research Nurse I Locations: Los Angeles, California Job Category: Registered Nurse Position Type: Full-Time Shift: Days Job Description Join a team that's...

Cambia Health Solutions is seeking an Appeals Clinician I to work from home within Oregon, Washington, Idaho or Utah. You will complete the clinical component of all appeal types to resolve member and/or provider appeals, leveraging nursing...

Description: FAMILY NURSE PRACTITIONER JOB SUMMARY Provides continuous and comprehensive services necessary for the promotion of optimal health, prevention and treatment, in an underserved community clinic. To perform a variety of advanced clinical...

Under general supervision and according to established policies and procedures, provide remote Blood Pressure (BP) monitoring for all patients enrolled in the Blip Care program. Communicates significant blood pressure changes and patient concerns...

Health Care Service Corporation seeks a Quality of Care (QOC) Nurse to review and investigate potential quality of care issues in a timely manner. This role supports QA activities in line with CMS and NCQA requirements, under the supervision of...

Care Career is seeking a travel nurse RN Labor and Delivery for a travel nursing job in Los Angeles, California. Job Description & RequirementsSpecialty: Labor and...

Freeman Health System is hiring for a remote/hybrid position in Utilization Review and Case Management. The role focuses on assisting Emergency Department patients with their social and discharge needs. Candidates must be licensed RNs with strong...

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.