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BJC HealthCare is seeking a registered nurse to join a remote Utilization Review team. The role supports multiple hospital units with no patient communication, and it is designed for local remote work with weekend rotation. Responsibilities...

Spectraforce Technologies, Inc. is seeking a Clinical Review Nurse - Prior Authorization to perform clinical reviews of authorization requests using established criteria, plan benefits, regulatory requirements, and internal policies.

CorVel Corporation seeks a Care Advocate Nurse for a remote role focused on assessing injury severity, reviewing medical data, and supporting the Claims Management department as a nurse consultant. The position requires clinical nursing...

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.

Yoh is seeking a Utilization Management Nurse Coordinator (RN or LVN) for a 6+ month remote contract with a managed care client based in Northern California. Training occurs onsite in Fairfield or Redding for three weeks, then transitions to fully...

CVS Health is seeking a Nurse Consultant for a remote role focused on inpatient clinical reviews. The position emphasizes collaboration with hospitals and care teams to ensure appropriate levels of care and efficient discharge planning from a...

Molina Healthcare in Columbus, OH is seeking a Care Review Clinician to provide prior authorization for behavioral health services for the OH Medicaid population. The role requires strong BH care experience across inpatient, substance use, and...

Virginia Mason Medical Center in the Puget Sound region seeks a Clinical Documentation Review Specialist (RN) to clarify patient records for appropriate reimbursement and care complexity. You will conduct concurrent reviews and engage with...

Trillium Health Resources is seeking a Compliance Nurse to perform clinical compliance reviews and evaluate claims to ensure adherence to regulatory and coverage requirements. The role applies clinical judgment to assess documentation, determine...

Clinical Nurse Professional Development Educator Advanced How would you like to work in a place where your contributions and ideas are valued? A place where you can serve with compassion, pursue excellence and honor every voice? At...

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...

State of North Carolina - Health & Human Services in North Carolina seeks a Nurse Consultant I who conducts regulatory nursing home inspections to ensure compliance with federal and state standards. The role involves travel across Central and...

Datavant is seeking a Coding Consultant Outpatient PRN to review medical records, assign accurate diagnoses and procedure codes, and ensure data quality for hospital statistics. This remote, part-time role requires AHIMA or AAPC credentials and 3+...

Cunningham Children0s Home in Urbana, IL seeks a Nurse Case Manager to support residential programs with medical case management, screening, education, counseling, and medication management, while networking with community health providers. The...

CVS Health Corporation is seeking a Utilization Management Nurse Consultant (UMNC) for a 100% remote role. You will coordinate, document and communicate utilization/benefit management activities, ensuring appropriate care and timing of services...

Overview St. Francis Medical Center is one of the leading comprehensive healthcare institutions in Los Angeles. St. Francis provides vital healthcare services for the 700,000 adults and 300,000 children in our community who count on the...

Healthcare Provider Solutions is seeking a Clinical Consultant to join our remote clinical consulting team. The role focuses on hospice quality assurance, chart reviews, and Medicare hospice issues, including ADR/UPIC/SMRC/OIG audits.

Sr. Clinical Coding Nurse ConsultantExplore opportunities with WellMed, part of the Optum family of businesses. We believe all patients are entitled to the highest level of medical care. Here, you will be part of a team who shares your passion for...

Sr. Clinical Coding Nurse ConsultantExplore opportunities with WellMed, part of the Optum family of businesses. We believe all patients are entitled to the highest level of medical care. Here, you will be part of a team who shares your passion for...

Regional Nurse Consultant (RNC)Sheridan Healthcare | Regional Corporate Clinical Role Shawnee Senior Living is proud to be part of the Sheridan Healthcare family of communities, a growing network of skilled nursing facilities throughout Illinois.

Qlarant, a nonprofit organization, seeks a Nurse Specialist II to perform medical record and claims review for Medicare, Medicaid, and other data. This remote role in the United States involves ensuring adherence to guidelines while assessing for...

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...

CVS Health is seeking a Telework RN with at least an Associate's degree and 3+ years of clinical nursing experience. The role focuses on precertification, reviewing clinical information from providers, and authorizing procedures or referrals.

Join the transformative team at City of Hope, where we're changing lives and making a real difference in the fight against cancer, diabetes, and other life-threatening illnesses. City of Hope's growing national system includes its Los Angeles...

Sagility is hiring an RN Utilization Management Reviewer for a fully remote, home-based role in the United States. You will perform day-to-day clinical and service authorization reviews for medical necessity and ensure compliance with CMS...