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Job Summary This position is responsible for ensuring compliance with Utilization Management (UM) and Quality Review (QR) functions performed by the health plan. The role supports clinical review activities requiring 5+ years of...

Alignment Health is seeking an inpatient review nurse to join the remote utilization management team. You will assist patients through the continuum of care in collaboration with the patient's primary care physician, facility case manager,...

Netsmart is seeking a registered nurse to perform utilization review for emergency department admissions and ongoing stay reviews. You will evaluate EMRs, apply InterQual/MCG criteria, and collaborate with ED physicians to determine admission...

Float Health is seeking an Intake Specialist to manage new patient referrals and coordinate start-of-care visits. This externally facing role requires quick action, clear communication, and meticulous attention to detail to ensure timely,...

Come care with us at West Coast University! As a Nursing Academic Specialist for a certified Great Place to Work, you will guide nursing students to do more than change their own lives – you will help change the lives of...

Machinify is seeking a Medical Review Nurse to perform CMS/RAC audits for government payers. This remote role involves working with a multi-location team to review claims, document findings, and support appeals. RAC certification is preferred and...

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...

HealthHelp, a WNS company, seeks a Clinical Review Nurse for a fully remote role in the United States. You will perform prospective reviews for medical necessity on prior authorization requests across multiple specialty programs and refer...

Who We Are: Since 1985, BHCHP's mission has been to provide or assure access to the highest quality health care for all individuals and families experiencing homelessness in greater Boston. We care for over 11,000 homeless individuals each...

Centene Corporation in the United States is seeking a Nursing professional to analyze prior authorization requests and determine medical necessity and level of care in line with standards and coverage. You will collaborate with medical teams to...

Masimo is seeking a Clinical Research Lab RN to join our team in Irvine, CA. You will perform venous sampling, IV placement, and arterial-line tasks while supporting R&D funding, regulatory filings, and marketing initiatives for Masimo products.

Registered Nurse Specialist Locations: Los Angeles, California Job Category: Registered Nurse Position Type: Full-Time Shift: Nights, Variable Job Description Join a team...

Job DescriptionDescription At UCLA Health, our love for our patients comes shining through during some of the most challenging times in their lives. Our nurses bring hope and healing to their patients through compassion,...

Location United States of America-USAUS Job Description Are you interested in joining a team of experienced healthcare experts and have the ability to shape and transform the healthcare delivery system? At our family of...

Secondary Review Nurse At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better.

CSL Behring is seeking a Nurse Resource Navigator to provide personalized education and support on gene therapy for the Hemophilia B community across the East Coast. You will educate patients, healthcare professionals, and families, guiding them...

Certified Nurse AssistantLocation: MLK-Recuperative Care Center, Los Angeles (CA)Position Purpose:Under the supervision of the Nurse Manager and Program Director, the Certified Nurse Assistant has the responsibility to engage with patients and to...

GQR Healthcare is seeking a travel nurse Correctional for a travel nursing job in Commerce, California. Job Description & RequirementsSpecialty:...

Fire Department Nurse Educator, Per Diem – Emergency MedicineWork Location: Los Angeles, CAJob #: 28350Work Hours: Varies depending on departmental needsEmployment Type: 6 – Staff- Per DiemDuration: IndefiniteSalary Range: $34.6-70.91...

Inland Empire Health Plan in California seeks an LVN-validated Claims Review Nurse to audit medical necessity across inpatient and outpatient claims and support the UM/Claims interface. You will analyze records, determine authorization needs, and...

U.S. Army Family Nurse Practitioners perform the highest level of quality care for Army Soldiers, retirees, and their families. If you are looking to combine your skills as a family nurse practitioner and your passion for...

Clinical Review Nurse - Concurrent Review TX All On-site Share on Job Description Location: 100% Remote - TX: RN only with TX license SHIFT: Tuesday – Saturday 8am-5pm CST- schedule is firm- no flexibility...

Optum CA is seeking a Nurse Practitioner/Physician Assistant to join our team in Torrance, CA. The clinicians we seek are those who practice...

Ensemble Health Partners is seeking a Virtual Utilization Review Specialist to join our remote team. You will perform medical necessity reviews, manage denials, and coordinate with FCC and care management to optimize patient care while controlling...

Syneos Health is seeking a Research Nurse (Per Diem) to support clinical trials remotely in IN. The role emphasizes protocol adherence, data integrity, and effective communication with the RN project team and investigators. The ideal...