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Optum is seeking a Utilization Review Nurse, RN, to lead inpatient utilization management, applying evidence-based guidelines and criteria to determine medical necessity for admissions and authorizations. The role requires 3+ years of...

Rochester Regional Health is seeking a Registered Nurse for the Communications Center (Central Triage). The role combines in-person duties at the Riedman Center with a remote option after completing an in-depth training program. Expect 40...

Provides direct nursing care including: assessment, plan of care, education, and evaluation for assigned patients. Performs patient duties necessary to maintain the flow of...

RWJBarnabas Health is seeking an experienced Registered Nurse for a remote, day-shift role in New Jersey. The RN will support virtual urgent care navigation, referrals, and care coordination while working with a multidisciplinary team to ensure...

ARC Group is seeking a Clinical Review Nurse for a 100% remote position. The role focuses on reviewing health claims, determining medical necessity, and ensuring alignment with national and local policies and standards of care. Must hold a...

Highmark Inc. is seeking a Case Manager to deliver comprehensive case management services to members, coordinating care plans and monitoring progress to improve outcomes while containing costs. You will assess needs, develop individualized...

A leading health company is seeking a remote RN Case Manager responsible for assessing and coordinating case management activities for members. Candidates must possess an active RN license and have at least 3 years of acute care experience. Strong...

Staffmark Group is recruiting a Registered Nurse for a remote role. Primary duties include reviewing peer review reports, ensuring evidence-based rationales, and ensuring compliance with client, contract, and regulatory standards. The ideal...

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...

Delivering high-quality nursing care remotely, the full-time Remote Care Nurse II will conduct patient assessments, develop care plans, and coordinate with healthcare teams to optimize patient outcomes through telehealth technologies.Key...

Humana is seeking a Utilization Management Nurse 2 to apply clinical nursing skills in coordinating, documenting and communicating medical services and benefit determinations. This remote role may require occasional travel to Humana's offices for...

Qualifications Basic Requirements: English Language Proficiency In accordance with 38 U.S.C. 7403(f), no person shall serve in direct patient care positions unless they are proficient in basic written and spoken English Graduate of a school of...

VA Greater Los Angeles Healthcare (VAGLAHS) seeks two RN professionals for Remote Patient Monitoring - Home Telehealth. You will oversee the nursing process, care coordination, patient education, and health promotion, collaborating with the...

St. Louis Children's Hospital is seeking an RN for after-hours triage and nursing support via the Answer Line. The role involves assessing patient needs, guiding care plans, and educating families within established guidelines. Part-time...

Illingworth Research Group is seeking a Per Diem Freelance Research Nurse to support patients in clinical studies by coordinating care and liaising with healthcare providers. The role involves guiding participants through study protocols,...

*NURSING AT CHILDREN'S HOSPITAL LOS ANGELES* As a nurse, you approach care with energy and resolve. When you join us, you'll find the perfect environment to develop your nursing career. We stop at nothing to make sure that every patient we see...

JOB DESCRIPTION This RN will act as a Care Review Clinician supporting our Medicaid members who have recently been admitted to this hospital. The Medicaid will support them to ensure a successful transition from inpatient...

Seeking a dedicated Registered Nurse California, the full-time remote RN will manage patient care for seriously ill patients through telemedicine, ensuring adherence to care plans and coordinating with interdisciplinary teams.Key...

Gainwell Technologies is seeking a Medical Reviewer (Registered Nurse) to support California healthcare programs. You will use clinical judgment to review medical records, healthcare services, claims, and authorization requests. You will...

Job Description Make a difference every single day! When the work you do every...

Broadway Ventures, a veteran-owned SDVOSB headquartered in Mississippi, seeks an experienced Registered Nurse to perform medical review of complex claims, pre-authorization requests, appeals, and fraud referrals. You will apply clinical expertise...

A healthcare recruitment firm is seeking a Lead Healthcare Recruiter (Utilization Management RN) for a remote 6-month contract. The ideal candidate will have an active RN license and experience with health plan operations. Responsibilities include...

JR Tele-Health Nurse (Remote/LPN) (Open) Full-time McKesson requires new employees to be fully vaccinated for COVID-19 as defined by the CDC, subject to applicable, verified accommodation requests. McKesson is in...

HealthDrive seeks a Remote Clinical Support Nurse (RN or LPN) to serve as the central hub for in-house NPs practicing in SNFs/ALFs. You will coordinate care, communicate with physicians, nurses, families, and pharmacies to prioritize needs and...

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...