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Under the direction of the Assistant Director, the Intensive Case Management Medicare Advantage Utilization Review Nurse performs utilization review of medical necessity and appropriateness, cost containment and efficiency, compliance with...

CVS Health is seeking a Case Manager RN for a fully remote role. The position supports members with assessment, planning, and advocacy to meet health needs and benefits, with no travel and a standard Mon-Fri schedule, aligned to the resident time...

Company : Highmark Inc. Job Description : JOB SUMMARY This job is responsible for providing comprehensive case management services to members, ensuring quality,...

Case Manager The Case Manager manages an individual caseload using the case management process in order to meet the needs of the MedWatch, LLC customers and consumers. This includes, but is not limited to, authorization of services,...

The Ohio State University is seeking a Clinical Financial Case Manager - RN to join our Revenue Cycle Clinical Support team in a remote capacity. The role focuses on securing pre-authorizations, preventing denials, and appealing denials with...

Care Career is seeking a travel nurse RN Care Manager for a travel nursing job in Burbank, California. Job Description & RequirementsSpecialty: Care...

We're building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold...

Offres d'emploi Crawford - Mondiales is seeking an RN Case Manager for the South Los Angeles County region. The role is remote with local field travel and offers a competitive salary, with quarterly bonus opportunities and resources such as free...

Molina Healthcare is seeking a remote RN Care Manager to support Washington State Medicare members via telephonic case management and care coordination. While remote, PST hours apply and candidates in WA state are preferred. No travel, no...

Alignment Health is seeking a compassionate Registered Nurse for a fully remote Telephonic RN Case Manager role serving SNP members from home. You will conduct telephonic care management, assess needs, and develop care plans while coordinating...

Centene Corp. in California seeks a remote nurse reviewer to handle medical necessity grievances, appeals and denials. The role requires CA RN/LPN/LVN licensure and 2+ years of clinical nursing experience, with NCQA and InterQual knowledge...

AmTrust Financial Services seeks a Telephonic Medical Case Manager (RN) to deliver comprehensive telephonic case management and drive appropriate return-to-work outcomes. You will collaborate with injured employees, providers, and adjusters to...

Medical Solutions is seeking a local contract nurse RN Case Management for a local contract nursing job in Burbank, California.Job Description & RequirementsSpecialty: Case ManagementDiscipline: RNDuration: 26 weeks40 hours per weekShift: 8 hours,...

TriHealth is seeking a Utilization Nurse to evaluate medical necessity and ensure care is delivered at the appropriate level in collaboration with physicians, care management, and payers. The role requires RN licensure, 3–4 years of...

To ensure high-quality patient care and appropriate admit status, the full-time Maryland Licensed Utilization Review Nurse will conduct admission concurrent and retrospective case reviews, collaborate with medical staff, and manage documentation...

Telephonic Nurse Case Manager Davies Claims North America is seeking an experienced Telephonic Nurse Case Manager to join our team. You will be responsible for the management and independent decision making on medical claims. You will...

UnitedHealth Group is seeking a registered nurse to provide guidance and education as part of a new program. The role emphasizes frontline clinical resource support, member education, and care coordination across the continuum of care. You...

UnitedHealth Group is seeking an experienced Behavioral Integration Nurse Case Manager to act as the clinical liaison between OptumCare/Care Delivery and the clinical network. The role focuses on assessing, coordinating, and evaluating care plans...

Full-time Company Description WHO IS GUIDEHEALTH? Guidehealthis a data-powered, performance-driven healthcare company dedicated to operational excellence. Our goal is to make great healthcare affordable,...

Sagility seeks an experienced Registered Nurse to join as a Senior Care Specialist in a work‑from‑home capacity. This seasonal role (ending June 2027) focuses on telephonic care, health coaching, and care coordination for members with chronic...

Host Healthcare is seeking a local contract nurse RN Case Management for a local contract nursing job in Gardena, California. Job Description & Requirements Specialty: Case Management Discipline: RN ...

Case Manager RN Paramount, CA $2425 /Weekly Gross* *Estimated pay package. Does not include taxes, insurance, or other deductions that may occur Start Date 11/2/2026 Shift 8H Days (8:00 AM-4:30...

Elevance Health is seeking a Nurse Case Manager II to oversee care management for members with complex and chronic care needs, assessing and coordinating care plans telephonically or on-site, including discharge planning. The role requires...

Field Case Manager Paradigm is an accountable specialty care management organization focused on improving the lives of people with complex injuries and diagnoses. The company has been a pioneer in value-based care since 1991 and has an...

Required Skills & Experience • Active RN license (Compact license required)\n• 2–4 years of clinical experience (neurology and/or endocrinology experience preferred)\n• Strong interest in chronic disease management across neuro and...