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JOB DESCRIPTION Opportunity in Southern California for an experienced Managed Care Leader to join our health plan in California. Candidates must have a minimum of 7 years of healthcare experience, 3 of those should be with a Managed Care...

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data...

Our client, a mutual benefit corporation and health plan provider, seeks an accomplished Registered Nurse (Utilization Management) .Candidate must be authorized to work in USA without requiring sponsorshipLocation: 100% Remote for California...

Moda Health in Oregon seeks an RN Case Manager to perform hospital/home health case management within accreditation standards. You will interact with members, families and providers to plan and monitor treatment, with a focus on timely,...

LanceSoft seeks an experienced RN Case Manager for a remote, fulltime role. The candidate will assess member needs, determine care plans, and advocate for access to benefits and services to meet health goals. Ideal applicants have 3+ years...

Humana is seeking a Utilization Management Registered Nurse to interpret and support coordination, documentation and communication of medical services and benefit determinations. You will report to the Manager of Utilization Management and...

Jobgether is seeking a Case Manager – Utilization Review Specialist for a remote United States position. You will use your nursing expertise to evaluate medical records, assess medical necessity, and manage appeals to support patient care and...

Telephonic Insurance Case Manager (RN) | ARIZONA RESIDENTS ONLY Insight Global is seeking a Telephonic Insurance Case Manager (RN) to join a growing and well-established organization focused on helping injured employees navigate their...

Sentara Health Plans seeks a Clinical Claims Reviewer RN for remote work. You will perform utilization management, review pre/post payment claims and authorizations for inpatient/outpatient cases, and address provider inquiries with appropriate...

Travel Nursing & Allied Healthcare Staffing Coast Medical Service is a nationwide travel nursing & allied healthcare staffing agency dedicated to providing an elite traveler experience for the experienced or first-time traveler. Coast is...

About This Role The Case Management Utilization RN works collaboratively with physicians to coordinate patient admissions and continued stays, ensuring appropriate care levels and safe discharge plans. This role is ideal for those who thrive in a...

A healthcare services provider is seeking a Remote Utilization Review Nurse to coordinate clinical resources, ensuring compliance with healthcare standards. Responsibilities include processing authorizations, reviewing documentation, and...

Clinical Liaison (RN/Allied Health Professional) Location: Remote (covering PA and NYC) Employment Type: Part-Time - Weekend Coverage 9a-5p Compensation: $55-$60/hr The Role Are you an...

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...

This is a fully remote position, open to candidates based in United States. Pay: $60–$70/hr Role Title: Registered Nurse Role Type: Contractor Location: United States,...

UnitedHealth Group's Optum Care at Home is seeking a Telephonic RN Case Manager to serve as primary contact for members with complex medical, behavioral health, functional, and social needs, coordinating care across Medicaid LTSS, home health, and...

CVS Health is seeking a nurse case manager to coordinate comprehensive care for members in Michigan. You will assess needs, develop care plans, and coordinate services with providers, insurers, and families. The role emphasizes advocacy,...

Get AI-powered advice on this job and more exclusive features. This range is provided by The Judge Group. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more. Base pay range...

Johns Hopkins Medicine in Westminster, MD is seeking a Registered Nurse Case Manager to join a newly established care coordination program. You will support high‑risk patients, coordinate care across providers, and deliver chronic disease...

Telephonic Nurse Case Manager: California RN License (Remote) Department: Claims Administration & Adjusting Employment Type: Permanent - Full Time Location: Home United States Reporting To:...

Registered Nurse-Remote Patient Monitoring Home Telehealth Case Manager Department: Department of Veterans Affairs The Remote Patient Monitoring Home Telehealth Case Manager delivers fundamental knowledge-based...

Humana Healthy Horizons seeks a Behavioral Health Case Manager in South Carolina to assess enrollees' needs and coordinate clinical, community, and social resources for complex cases. This remote/field-based position requires travel, including to...

Overview Our client is a trusted leader in healthcare services, dedicated to improving outcomes for patients and providers through innovative solutions and high-quality care. Join a team committed to making a meaningful difference in the...

Ensemble Health Partners is seeking an experienced RN for Utilization Review to assess medical necessity and optimize hospital and patient care. This remote role involves coordinating with the FCC, care management, and interdisciplinary teams to...

U.S. Department of Veterans Affairs is seeking a Remote Patient Monitoring Home Telehealth Case Manager. The role focuses on delivering knowledge-based care, patient education, self-management support, and ensuring patient satisfaction...