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TriWest Healthcare Alliance seeks a Utilization Management Clinical Review nurse to evaluate and authorize beneficiary care, focusing on cost-effective, appropriate utilization of Behavioral Health and Medical/Surgical services.

CVS Health Corporation seeks an experienced Registered Nurse (RN) to support 24/7 Utilization Management operations. You will review cases, assess medical necessity, coordinate care, and ensure members receive appropriate, high-quality healthcare...

Cunningham Children's Home in Illinois seeks a Nurse Case Manager to support residential programs with medical case management, screening, education, counseling, and medication management. The role involves coordinating with community providers...

Clinical Documentation Specialist Joining AdventHealth is about being part of something bigger. It's about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit.

UnitedHealth Group's Optum Care at Home is hiring a Telephonic RN Case Manager to serve as primary contact for members with complex needs, conducting telephonic assessments, creating care plans, coordinating transitions, and addressing barriers to...

Company Details Berkley Medical Management Solutions (BMMS) provides a different kind of managed-care service for W.R. Berkley Corporation. We believe focusing on an injured worker's successful and speedy return to work is good for people...

JOB DESCRIPTION Job Summary Work Location: California - Ability to work remote, but selected candidate must reside in the state of California. This position requires California RN Licensure. Candidates must...

Trillium Health Resources is seeking a Compliance Nurse to perform clinical compliance reviews and evaluate claims to ensure adherence to regulatory and coverage requirements. The role applies clinical judgment to assess documentation, determine...

CVS Health is seeking a Nurse Consultant for Utilization Management in a 100% remote role. You will apply clinical judgment and evidence-based criteria to review inpatient and outpatient services, collaborate with providers to authorize care, and...

Job Title Works collaboratively with an MD to coordinate and screen for the appropriateness of admissions and Continued stays. Makes recommendations to the physicians for alternate levels of care when the patient does not meet the medical...

Guidehealth is seeking an Utilization Management Registered Nurse to perform medical-necessity reviews and document findings for determinations. The role involves collaborating with medical leadership, reviewing cases for appropriate treatments,...

A health care provider organization is seeking a Case Management Nurse to coordinate care for members. This role requires a Nursing Diploma and direct clinical experience, along with the current Michigan RN license. Responsibilities include...

Field Based Nurse Case Manager – RN OHARA, LLC has an opening for a full-time Field Based Nurse Case Manager in the Kansas City, MO area. We are driven to facilitate prompt delivery of quality, cost-effective health care to...

HonorHealth in Phoenix is seeking an Utilization Review RN Specialist to review and monitor utilization, ensuring medically necessary care and appropriate discharge planning within Medicare, AHCCCS, Self-pay, and other payer guidelines. The...

Position Summary The Care Navigator will be responsible for case management specific to kidney health management. The Care Navigator will complete activities for the continuum of care to facilitate and promote high quality, cost-effective...

Humana is seeking a Utilization Management Nurse to support coordination, documentation, and communication of medical services and benefit determinations. This role suits experienced nurses who can work independently and make critical patient-care...

Utilization Management Nurse Consultant Clinical Precertification RN (Medicare Home Care) Remote | Full-Time | Weekday Schedule We're building a world of health around every individual - shaping a more connected, convenient and...

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...

Utilization Review Nurse - RN | 100% Remote | Part-Time 10-20 Hours Per Week | Flexible Schedule | Evenings & Weekends Looking for a way to use your nursing experience without returning to a full-time bedside...

About the Job This position reports to the Enhanced Care Management (ECM) Program Manager this position provides support to the ECM Program to ensure engagement, enrollment and follow up on members related to the ECM as well as other...

Elevance Health is seeking a Telephonic Nurse Case Manager II to coordinate care for members with complex needs via telephone, enabling virtual work with mandatory in-person trainings as required. Candidates must hold an RN license and have...

Our promise to you: Joining AdventHealth is about being part of something bigger. It's about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is...

Brundage Group is seeking a Utilization Review Nurse for a PRN weekend shift in a fully remote Florida role. The UR Nurse reviews admissions and continued stays to ensure medical necessity and payer compliance, collaborating with physicians and...

Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the...

Actalent seeks an LVN Nurse Consultant for a fully remote, contract-to-hire role based in Dallas, TX. Schedule is M-F with daytime CST hours; pay is 29.00 USD per hour. The role focuses on telephonic patient support, therapy adherence, and...