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Program Integrity Clinical Compliance AuditorOptum Insight is improving the flow of health data and information to create a more connected system. We remove friction and drive alignment between care providers and payers, and ultimately consumers.

Patient Chart ReviewerIn this position you will be reviewing patient charts to determine if pre-elective surgical cases should be boarded as inpatient instead of outpatient. You will also review the CPTs that were boarded for meeting inpatient on...

Description: Job Summary: 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...

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...

At UK King's Daughters, we're not just a healthcare facility - we're a family of dedicated professionals who share a passion for making a meaningful difference in the lives of our patients. We're more than just a place to work; we're a place to...

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...

Clinical Documentation Integrity Specialist IIThe Clinical Documentation Integrity Specialist II (CDI) is responsible for utilizing independent clinical judgement in facilitating the integrity, overall quality, accuracy, and completeness of...

Job Summary CVS Health is seeking a dedicated Drug Utilization Review (DUR) Technician to join our growing remote pharmacy operations team. In this role, you will play a critical part in ensuring patient safety and medication effectiveness through...

Job OverviewPay Range: $46.76hr - $51.76hrRequirement/Must Have5+ years Clinical nursing experience.2+ years Care Management.Bachelor's Degree in Nursing.In lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required...

Overview At Centinela Hospital Medical Center, our dedicated team of professionals are committed to our core values of quality, compassion, and community. As a member of Prime Healthcare, a Top-15 hospital system in the United States, Centinela...

Summary: Uniti Med is looking for a (LPN/LVN) Licensed Practical/Vocational Nurse in Los Angeles, California. This assignment lasts 13 weeks and is scheduled to start on 11-02-2026.

Medical Solutions is seeking a local contract nurse RN Case Management for a local contract nursing job in Burbank, California. Job Description & Requirements Specialty: Case Management Discipline: RN ...

The Manager of Case Management is accountable for overseeing all aspects of daily operations of the Case Management Department. Ensures standards of operations are in accordance with all state and federal healthcare regulatory guidelines. Works...

Self Fund Health Nurse Navigator Remote · Full time The Nurse Navigator is a remote WI-based RN who acts as the member's single point of contact through the healthcare system — coordinating care, advocating for patients, and steering...

Job Description: Join a compassionate hospice team where your nursing expertise helps patients experience comfort, dignity, and quality of life in the place they call home. As a Hospice RN, you'll provide individualized, patient-centered care...

Molina Healthcare is hiring a remote RN Care Manager. Preference for candidates in Washington State. This role will be working Pacific Standard Time hours. This role supports Medicare members through telephonic case management and...

Description: Job Summary: Works collaboratively with an assigned panel of physicians to manage the patients specialized needs. The managing team does differ according to the chronic disease. Duties include assessment to identify...

Enlyte is seeking a Field Case Manager (RN) in the Torrance, CA area. This full-time, hybrid role requires regular local travel for in-person patient appointments. Spanish is preferred.The position includes a comprehensive benefits package, paid...

At Duke Health, we're driven by a commitment to compassionate care that changes the lives of patients, their loved ones, and the greater community. No matter where your talents lie, join us and discover how we can advance health together.Patient...

Molina Healthcare is hiring a remote RN Care Manager. Preference for candidates in Washington State. This role will be working Pacific Standard Time hours. This role supports Medicare members through telephonic case management and...

Job ID:26-134888 Job Title: Licensed Vocational Nurse Position Type: Full-Time Contract Role Location:Fully Remote Work Type: Work from Home Est. Pay Range: $25.00/Hour to $28.00/Hour on W2 (USD) Schedule: 8-hour shift Monday to Friday anywhere...

Enlyte in Downey, CA is seeking a Field Case Manager (RN) to lead workers' compensation case plans, coordinating with physicians, employers, and patients to ensure effective and timely recovery and return-to-work.The ideal candidate has 2+ years...

We are seeking Registered Nurses with at least 5 years of clinical experience to join our internal data annotation team.You will review agent conversations spanning primary care, chronic disease management, care management, medication adherence,...

Job DescriptionDescriptionThe AN I as a clinical lead and is responsible for coordination of patient care activities and workflow within the Surgery Center Operating Room. Acts as a clinical and administrative resource to staff and provides work...

Conduct nursing assessments and enroll patients in chronic care management.Develop care plans and coordinate transitions across healthcare settings.Collaborate with teams to improve quality and value-based outcomes.Requirements:Active RN license...