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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...

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...

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...

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 Summary and Responsibilities* As our Clinical Nurse, you will be a central figure in our patient care team, delivering exceptional, compassionate care that truly makes a difference in our patients' lives. Every day you will collaborate...

Army Public Health Nurse Job Overview As an Army Public Health Nurse, you'll assess health risks and implement programs to monitor the spread of disease. You'll promote wellness for Soldiers and their families while also informing policy and...

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...

Molina Healthcare is seeking a field-based RN care manager to support LTSS across Lawrence and Gallia County areas. You will assess, plan, implement, and monitor member care, coordinating with a multidisciplinary team to ensure outcomes and...

The Ohio State University is seeking a Staff Nurse (RN) for Oncology Continuing Care Triage. This remote phone triage role handles oncology patient calls, performs initial assessments, and uses triage algorithms to guide care. The nurse documents...

Trillium Health Resources is seeking a Population Health Nurse to provide clinical care management and population health support for assigned members, focusing on prevention, wellness, and outcomes. The role uses nursing judgment as an RN to...

Atrius Health, part of the Optum family, seeks an experienced Registered Nurse to deliver patient care remotely in Massachusetts, aligning with RN protocols and evidence-based practice. In this role, you will build therapeutic...

Prolific is seeking Registered Nurses to help train and evaluate AI models. You'll be invited to join Prolific as a Domain Expert participant, paid to train and evaluate AI models. Researchers may pay up to $65/hr per task, with many tasks...

Job Description & Requirements Family Medicine Nurse Practitioner or Physician Assistant(NP) StartDate: ASAP Available Shifts: Day 8 Pay Rate: $72.75 - $78.75 This facility is seeking a Family Medicine Nurse Practitioner or...

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process. Part Time Southborough, MA, US Salary Range: $38.00 To $40.00...

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...

UnitedHealth Group is seeking a Patient Care Coordinator to support the National Start of Care Nursing Team. The role involves nursing coordination for infusion services, managing referrals, intake and patient management, and coordinating with...

Umpqua Health in remote Oregon seeks a Care Coordinator to manage care for Medicaid/Medicare members. You will conduct in-home assessments, develop care plans with families and providers, and coordinate services across LTSS, behavioral health, and...

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:...

Home Health Clinical Referral NurseOrganization: SCAH-Sutter Care at Home - UTPosition Overview: The Home Health Clinical Referral Nurse serves as the initial point of contact for potential home health patients, working closely with our clerical...

Job Description: The Licensed Practical Nurse (LPN) performs a variety of delegated nursing tasks and participates in patient care within their Scope of Practice, guided by registered nurses, licensed physicians, or other specified health care...

Full-time Company Description WHO IS GUIDEHEALTH? Guidehealthis a data-powered, performance-driven healthcare company dedicated to operational excellence. Our goal is to make great healthcare affordable,...

Compassus is seeking a Hospice RN Clinical Coordinator to oversee administrative and management functions in the absence of the Director of Clinical Services. May carry caseload and ensure compliance with state and federal regulations. Remote role...

Sedgwick is seeking a Telephonic Case Manager to support injured workers nationwide from a remote environment. You will craft case management strategies, advocate for optimal medical treatment, and coordinate services to facilitate recovery and...

Humana is seeking a Pre-Authorization Nurse to review requests for medical necessity and level of care, working remotely from Virginia or a compact-licensed state. You will educate providers, document clinical data, and make independent...

WNS, part of Capgemini, seeks a remote Utilization Review Nurse to perform medical necessity reviews and collaborate with providers to ensure compliant patient care. The role emphasizes adherence to HIPAA, state and federal regulations, and a...