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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...

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...

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...

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...

Description At ScionHealth, we empower our caregivers to do what they do best. We value every voice by caring deeply for every patient and each other. We show courage by running toward the challenge and we lean into new ideas by embracing...

DRG Specialist UPMC Corporate Revenue Cycle is hiring a DRG Specialist to work on inpatient auditing within our Coding Department. This position will be a work-from-home position working during standard business hours Monday through...

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...

This range is provided by Insight Global. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more. Base pay range $140,000.00/yr - $170,000.00/yr Direct message the job poster from...

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,...

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...

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.

Actalent seeks a Care Management Coordinator (RN) to lead an Adult Case Management program in a primarily remote setting. You will supervise staff, drive quality initiatives, and ensure member-centered care delivery. The ideal candidate...

Revive Therapeutic Services seeks a Nurse Case Manager to oversee patient care plans and coordinate services for individuals facing health challenges. You will collaborate with patients, families, and providers to ensure effective care delivery.

Lee Health is hiring for a Utilization Management RN position. This remote role begins onsite for the first 90 days and requires licensure in Florida. The nurse will perform utilization management duties, ensure regulatory compliance, and document...

CVS Health is seeking a Nurse Consultant for Utilization Management in a 100% remote capacity. The role reviews inpatient and outpatient services using evidence-based criteria, authorizes care with providers, and escalates cases as needed.

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system...

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...

Family Advocate Support Care - Senior Clinical Admin Nurse At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of...

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...

Optum is seeking an experienced Telephone Case Manager RN to support a diverse member population with education, advocacy, and connections to necessary resources. This remote role operates Monday through Friday, 8 AM–8 PM, nationwide across the...

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 compassionate...

Back RN/Managed Care Coordinator - Remote Healthcare Columbia , South Carolina Contract Hybrid Oct 9, 2026 RN/Managed Care Coordinator - Remote Job at a Glance Title:RN/Managed Care...

Santa Barbara Cottage Hospital is seeking an experienced RN/LPN to perform remote clinical reviews for appeal cases. You will review medical records, apply InterQual criteria, and prepare clinical determinations for physician review. The...

nirvanaHealth, a RxAdvance Corp. company, seeks a part-time Utilization Management Nurse for a remote role in the United States. You will perform prospective, concurrent, and retrospective medical necessity reviews and care coordination to ensure...

Find your calling at Mercy! The Nurse Navigator is a leader providing support, mentorship, and guidance to those who provide direct patient care. The Nurse Navigator coordinates the delivery of patient care by...