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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...

Community Health Network is seeking an Ambulatory Triage Registered Nurse to join the Family Medicine Care team. The RN will perform phone triage, patient education, scheduling, prior authorizations, prescription refills, referrals and care...

Northwell Health is seeking a Registered Nurse CDI Auditor to validate acute inpatient coded charts and ensure documentation substantiates diagnostic information. This remote position in New York requires a NY RN license, a BSN, and strong...

Harris Health is seeking a Nurse Manager to oversee operations and care delivery for one or more clinics or units. You will manage human resources, quality, and financial aspects while aligning with nursing leadership and professional practice...

Inland Empire Health Plan (IEHP) seeks a Quality Program Nurse to implement and monitor quality management policies under the DHCS framework. Responsibilities include site reviews, medical record surveys, CAP oversight, and HEDIS data abstraction.

To support a growing healthcare team, the full-time Remote RN Care Manager will manage an assigned patient panel, focusing on individual healthcare needs, collaborating with interdisciplinary teams, and advocating for patients while working...

Telenett is seeking a Remote Utilization Review Nurse to review medical records from a home office and determine medical necessity and care appropriateness. You will work with providers to develop compliant care plans and ensure high-quality,...

Overview: Mountain Ridge is HIRING MDS Coordinator Flexible Schedule - Full time OR Part time This is not a remote role, onsite is required Offering $10,000 Bonus We are dedicated to improving the lives we touch through the delivery of...

Peraton's SafeGuard Services seeks a Nurse Reviewer to conduct medical record reviews, applying clinical judgment to claim payments and supporting fraud investigations. Telework is available from any state. The ideal candidate will hold a...

Greenlife Healthcare Staffing is looking for a dedicated Registered Nurse Clinical Reviewer for a fully remote position in New York. This role involves conducting utilization and quality reviews and contributing to clinical studies. With a...

RN opportunity with out the bedside burnout + sign on bonus. This Jobot Job is hosted by: Dexter Dionio Are you a fit? Easy Apply now by clicking the "Apply" button and sending us your resume. Salary: $80,000 -...

Sinai Hospital's Utilization Review operates as a distinct specialty service line of physician advisors, nurses, and support staff who ensure hospital stays are clinically appropriate and fully covered by the patient's insurance. The team focuses...

A healthcare technology company in the United States seeks a Triage Registered Nurse to provide effective telephone triage for patients. The ideal candidate will have a BSN, strong clinical assessment skills, and at least 2 years experience in...

A staffing and recruiting firm is seeking a HEDIS Nurse (RN or LPN) for a remote position which allows for a flexible schedule. This high-impact role involves ensuring accurate HEDIS reporting and quality improvement initiatives. Candidates should...

A healthcare company is seeking a compassionate and detail-oriented RN Triage Nurse for a remote role based in Charlotte, NC. Ideal candidates will have at least 5 years of experience in nursing, particularly in emergency departments or call...

Job ID: 31089 *Description*Become a key member of a world-class health organization. Contribute to the delivery of Magnet® designated nursing excellence. Take your career to the next level. U can do all this and more at UCLA Health. In this...

TEKsystems in Texas (remote) is seeking an experienced Registered Nurse to transition from bedside care into care coordination, member advocacy, and improved health outcomes. This fully remote role supports high-risk populations while balancing...

Job Title: Registered Nurse (RN) Disease Manager Job Overview: The Registered Nurse (RN) Disease Manager is responsible for coordinating care and managing the health outcomes of patients with chronic or...

A healthcare quality organization is seeking a Nurse Reviewer to perform comprehensive medical necessity reviews for Medicaid claims. The ideal candidate will have a BSN and an active RN license, along with experience in medical record review.

UnitedHealth Group seeks an Inpatient Care Management Nurse to ensure proper utilization of health services for members. You will assess needs, plan care, and collaborate with physicians to expedite appropriate levels of care. The role...

Remote position, however, candidates must reside in the State of TX or State of IL. This position is a contract for about 9 months. Pay: $41/hour Job Responsibilities: RN working in the insurance or managed...

Description We are looking for a full-time LPN passionate about all aspects of women's health to provide direct patient care as part of an interdisciplinary care team and to serve as the first line of communication with patients in...

A prominent healthcare organization is seeking an A&G Clinical Specialist to manage health member complaints and appeals. This fully remote position requires expertise in clinical case management, understanding of regulatory compliance, and the...

Salvo Health is hiring a Registered Nurse for a remote telehealth role focused on chronic gut health and metabolic conditions. You will provide disease management, health education, and coordinated care within a whole-patient approach.

Description 3 years of recent ED registered nurse experience strongly preferred. 1 years of recent leadership experience strongly preferred. Location: UCHealth UCHlth Emerg Aurora Central, US:CO:Aurora Department: Aurmiss Free Standing ED Work...