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It takes great medical minds to create powerful solutions that solve some of healthcare's most complex challenges. Join us and put your expertise to work in ways you never imagined possible. We know you've honed your career in a fast-moving...

Sagility combines industry-leading technology and transformation-driven BPM services with decades of healthcare domain expertise to help clients draw closer to their members. The company optimizes the entire member/patient experience through...

Sentara Health Plans seeks a Clinical Claims Reviewer RN for remote work. You will perform utilization management, review pre/post payment claims and authorizations for inpatient/outpatient cases, and address provider inquiries with appropriate...

Job Summary: As the leader of the health care team, provides professional nursing care, utilizing the nursing process in accordance with established standards of care, policies, and procedures. Demonstrates performance...

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. Clinical Reviewer RN - Alabama Alabama, US 30+ days ago Requisition...

We are sharing a specialised remote consulting opportunity for experienced Registered Nurses with strong expertise in inpatient clinical care, nursing documentation, medical record review, clinical judgment, and healthcare quality assurance to...

Exceptional care starts with exceptional people. For us, this is more than a job- it's a calling. It's waking up each day, looking for ways to make a difference with a compassionate, inclusive and talented team. Ochsner empowers you to...

American Health Plans, a division of Franklin, Tennessee-based American Health Partners Inc. owns and operates Institutional Special Needs Plans (I-SNPs) for seniors who reside in long-term care facilities. In partnership with nursing home...

Reviewing and resolving insurance denials, the full-time remote RN Appeal Specialist II will analyze claims for reimbursement accuracy, collaborate with internal teams for appeal resolutions, and provide trend reporting on denials.Key...

Humana is seeking a Utilization Management Registered Nurse to interpret and support coordination, documentation and communication of medical services and benefit determinations for post-acute care services including SNF, home health and DME.

CVS Health is seeking a Utilization Management Nurse Consultant (Medical Review) to ensure members receive timely, medically necessary care through thoughtful clinical review and collaboration with providers. This fully remote role leverages your...

This position will be paying $26.50/hr for an LPN and $28.50/hr for an RN Job Description The Clinical Quality Assurance Coordinator is responsible for ensuring case reports are of the highest quality and integrity and in full...

Sedgwick is hiring for a Clinical Consultation Triage Nurse in a remote, full-time role. You will triage calls, assess needs, and provide care guidance to determine the appropriate level of care, while supporting return-to-work goals. The...

Nurse Consultant I (NS) The North Carolina Department of Health and Human Services (DHHS) is one of the largest, most complex agencies in the state, and has approximately 17,000 employees. It is responsible for ensuring the health,...

Care Management Nurse Consultant Competitive Compensation & Benefits Package! Position eligible for: Annual incentive bonus plan Medical, dental, and vision insurance with low deductible/low cost health plan...

Job Summary and ResponsibilitiesAs our Educator in Critical Care Emergency, In accordance with our mission and core values of integrity, compassion, collaboration, and excellence, this position is established to serve as a consultant/resource...

A healthcare technology company seeks an experienced Registered Nurse for a remote role providing clinical technology services. This position is for independent contractors, focusing on chart reviews and clinical data analysis. Candidates should...

Registered Nurse (RN) - Utilization Management 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...

American Health Plans Franklin, TN 37067, USA Description American Health Plans, a division of Franklin, Tennessee-based American Health Partners Inc. owns and operates Institutional Special Needs Plans (I-SNPs) for seniors...

Centene Corp. is seeking a fully remote nurse reviewer to evaluate concurrent care plans and determine appropriate levels of care for members. The role prefers an active NY State RN license and requires availability Monday–Friday, 8:30 AM–5:00...

Guardian Life is seeking a highly skilled RN Clinical Consultant to support short-term and long-term disability claims in a fully remote role across the United States. You will analyze medical information, assess functional capacity, and provide...

Comagine Health is seeking an experienced Registered Nurse to serve as a Clinical Reviewer for the Washington Labor & Industries (L&I) contract. This remote role utilizes nursing expertise to evaluate medical necessity and quality of care,...

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A technology and business consulting firm is seeking a Clinical Medical Review Nurse to analyze health data and provide insights for internal stakeholders. The ideal candidate has a Registered Nurse license, along with four years of clinical...

CVS Health is seeking a registered nurse to assess, plan, implement, coordinate and evaluate healthcare options for members. The role focuses on coverage determination and coordination within the utilization management framework. The...