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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...

Elevance Health is seeking a Nurse Case Manager I (US) to perform care management for members with complex needs. The role can be remote full-time with required in-person training and occasional site visits, centered in Latham, NY. The...

Sedgwick is seeking a US Telecommuter RN Telephonic Case Manager for a full-time remote role. You will support injured workers, employers and providers, coordinating medical services and advocating for timely recovery and return-to-work.

CorVel is seeking a Utilization Review Case Manager to gather demographic and clinical data for in-patient and outpatient reviews, certify medical necessity, and assign appropriate LOS while supporting the Case Management department's goals. This...

The Elevance Health Companies, Inc. in California is seeking a Telephonic Nurse Case Manager II to assess, plan and coordinate care for members with complex needs. This hybrid/remote role allows remote work with required in-person training...

Elevance Health is seeking a Nurse Case Manager I in Latham, NY, to perform care management for members with complex chronic needs, assessing, developing, implementing, coordinating, monitoring, and evaluating care plans. Roles may be telephonic...

Hines & Associates, Inc. seeks a Registered Nurse reviewer to assess patient conditions and certify treatments according to URAC and applicable regulations. The role emphasizes clinical judgment, documentation, and collaboration with case managers...

Womble Bond Dickinson (US) LLP seeks a Nurse Consultant to join our team. The Nurse Consultant provides high-level medical analysis and insight in support of legal matters, reviewing, interpreting, and synthesizing complex records into clear,...

Kindred Hospital San Gabriel Valley Care Coordinator Kindred Hospital San Gabriel Valley is a 76-bed long-term acute care hospital offering the same in-depth care you would receive in a traditional hospital, but for an extended recovery...

A leading healthcare company is seeking an experienced Telephonic Nurse Case Manager to manage medical claims and facilitate care for injured workers. The ideal candidate will have at least a year of experience in Florida Workers' Compensation,...

Engage patients telephonically to assess needs and prioritize care.Collaborate with providers to coordinate care and transitions.Provide education and resources to patients and caregivers.What Will Make You Successful Here: Hold an active RN...

Company Overview At Enlyte, we combine innovative technology, clinical expertise, and human compassion to help people recover after workplace injuries or auto accidents. We support their journey back to health and wellness through our...

HealthHelp, a WNS company, seeks a Clinical Review Nurse for a fully remote role in the United States. You will perform prospective reviews for medical necessity on prior authorization requests across multiple specialty programs and refer...

For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing...

OverviewStart your day from a home office!2-3 assessments per day! About us: Fallon Health is a company that cares. We prioritize our members—always—making sure they get the 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...

ISYS Case Management is seeking a Telephonic Case Manager (RN, RN-BC) to operate remotely from Tampa or surrounding areas. You will provide telephonic case management for injured workers, coordinating care with providers, carriers, employers and...

A leading staffing company is seeking a remote Case Manager RN to coordinate care for a diverse health plan population. Applicants must hold an active nursing license in Michigan and have at least three years of clinical experience, alongside...

Redesigning heart health via virtual cardiac rehab for older adults.Mission-driven team of clinicians and engineers.Responsibilities:Review EMRs to determine eligibility and create orders.Conduct video intake assessments and treatment...

Centene is seeking a Clinical Review Nurse for a remote role supporting members in Pennsylvania. The candidate will perform concurrent reviews, assess care necessity, and contribute to discharge planning, leveraging case management or utilization...

Immediate need for a talented Utilization Management RN - Prior Authorization. This is a 12+ Months Contract opportunity with long-term potential and is located in US (Remote). Please review the...

CHOICES Case Management, Inc. is seeking an Administrative Assistant to support our Nurse Case Managers in a fast-paced healthcare environment. This role serves as the operational backbone, ensuring details are handled, communication flows...

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...

Secondary Review 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 millions of people for the better.

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...