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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,...

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 does not meet the medical...

Wellmark, Inc. is seeking a Case Management Nurse I to support members with chronic and complex health needs. You will develop individualized care plans, coordinate with providers and resources, and guide members through care pathways in a...

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...

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.

CVS Health is seeking an experienced RN Case Manager for a remote role across the United States. The position involves telephonic case management of members, applying clinical guidelines, and coordinating care with care teams to optimize outcomes.

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...

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.

Renown Health is seeking a Utilization Management RN to apply medical necessity criteria for prospective and concurrent reviews. You will work with an interdisciplinary team to ensure medically necessary, cost-effective care at the appropriate...

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...

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...

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...

Case Manager LVN Days Join our team in Los Angeles, CA, as a Case Manager LVN, focusing on patient care coordination and discharge planning. Position Details: Contract: 13 weeks, 40 hours/week, 9am-5:30pm, includes...

The RN Clinical Educator, Ancillary Services is an advanced clinical expert in Cath Lab and procedural-based services who supports the professional growth, development, and competency validation of staff in Ancillary Services including Cath...

Akima Global Logistics (AGL) is seeking a skilled Registered Nurse to support medical clearance processes for ATC candidates. The role centers on assessment, case management, scheduling, and coordination with medical providers, with options for...

WORK REMOTELY after training! CANDIDATE MUST RESIDE IN THE METROPOLITAN NEW YORK AREA! !! Process all requests for services in accordance with Medicare and NYS Medicaid guidelines as well as departmental criteria and...

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...

Behavioral Health Utilization Reviewer The Behavioral Health Utilization Reviewer is responsible for conducting clinical reviews of behavioral health service requests, claims, and appeals to confirm medical necessity and appropriateness...

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...

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...

Authorization Nurse Do you have clinical care experience? Are you an RN looking to grow your career? UPMC is hiring a full-time Authorization Nurse. This position works Monday through Friday, as well as rotating weekends (typically 1...

UnitedHealth Group is seeking a Telephonic RN Case Manager to act as the primary contact for members with complex medical and social needs. You will conduct telephonic assessments, create person‑centered care plans, and coordinate services...

Job ID: 33380 *Description*There's nothing more exciting and rewarding than being able to make a significant, positive difference in someone's life. At UCLA Health, you'll experience this joy every day while also enjoying the positive,...

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...

Ansible Government Solutions, LLC is recruiting multiple Remote Registered Nurse Case Managers to support the VA Office of Veterans Community Care. The role involves managing SEOC data, ensuring compliance, and reviewing provider and veteran...