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A prominent healthcare provider is seeking a Nurse Reviewer I for a virtual position responsible for conducting reviews of diagnostic imaging services. The ideal candidate should possess an AS in nursing and clinical nursing experience, alongside...

Current Employees: If you are currently employed at any of the Universities of Wisconsin, log in to Workday to apply through the internal application process. Job Category: Academic Staff...

Registered Nurse Case Review Specialist Position is Remote/Nationwide Job Summary STGi is currently seeking a Registered Nurse Case Review Specialist. The position is remote and open to candidates nationwide. Provides direct...

Job Description: • Participates in the development and ongoing implementation of QM Work Plan activities. • Improve quality products and services, by using measurement and analysis to process, evaluate and make recommendations to meet...

Make it happen at Hopkins Provides disease case management oversight of chronic conditions (i.e CHF, COPD, Diabetes, asthma etc.) in adult population using remote patient monitoring as a tool. Responsible for all aspects of remote...

Clinical Documentation Improvement (CDI) Specialist Registered Nurse (RN) When you join the growing BILH team, you're not just taking a job, you're making a difference in people's lives. This position is remote. Candidates must be local...

Description & Requirements Be part of something great Maximus is a global organisation that specialises in providing health and employment services to millions of people every year. Here in the UK we employ...

A health services organization is seeking a Prior Authorization RN to join their Wisconsin Medicaid Market team. This role involves reviewing clinical appropriateness of prior authorization requests in accordance with Medicare/Medicaid guidelines.

Overview The challenges of affordable healthcare continue to create new opportunities. Elderplan and HomeFirst, our Medicare and Medicaid managed care health plans, are outstanding examples of how we are expanding services in...

$40/hour - Contract for 6 months Must reside in TX Full time remote Candidates must be based in TX. RN working in the insurance or managed care industry using medically accepted criteria to validate the medical...

Pre-Access Utilization Management Registered Nurse Insight Global is looking for a Pre-Access Utilization Management Registered Nurse to sit remotely with one of their large health insurance clients. This person will be responsible for...

JOB DESCRIPTION Job Summary Provides support for medical claim and internal appeals review activities - ensuring alignment with applicable state and federal regulatory requirements, Molina policies and procedures, and medically...

Overview What you can expect! Find joy in serving others with IEHP! We welcome you to join us in healing and inspiring the human spirit and to pivot from a job opportunity to an authentic...

What You'll Do: The Ohio Department of Health / Complex Medical Help program is looking for an experienced nursing leader to oversee statewide public health nursing programs, guide policy development and ensure consistent,...

A healthcare organization is seeking a Registered Nurse Care Manager to provide member-centric case management services. This role includes conducting assessments and care coordination while ensuring that health needs are met through effective...

About the job Registered Nurse - Remote Company Overview: Confident Staff Solutions is a leading staffing agency in the healthcare industry, specializing in providing top talent to healthcare organizations across the country. Our...

A healthcare innovator in California is seeking a Registered Nurse to provide remote care as part of a telehealth team. Responsibilities include conducting assessments, educating patients, and ensuring compliance with healthcare regulations.

A healthcare consulting firm is seeking a Clinical Lead Consultant to join their team in Toledo, Ohio. This full-time, remote role involves consulting services for nursing facilities and includes responsibilities like MDS completion, auditing, and...

The RN Case Manager is responsible for coordinating continuum of care activities for assigned patients and ensuring optimum utilization of resources, service delivery, and compliance with medical regime. Essential Duties and...

Explore opportunities with [agency name], a part of LHC Group, a leading post-acute care partner for hospitals, physicians and families nationwide. As members of the Optum family of businesses, we are dedicated to helping people feel their best,...

Resp & Qualifications PURPOSE: The Clinical Appeals Nurse completes research, basic analysis, and evaluation of member and provider disputes regarding adverse and adverse coverage decisions. The...

The Nursing Home Administrator provides leadership and direction for overall facility operations to provide quality patient care in accordance with all laws, regulations, and Life Care standards. Your duties will including overseeing key areas...

A leading claims management company is seeking a part-time nurse in Jefferson City, Missouri. This role involves triaging calls to assess patient needs and providing appropriate medical advice. Candidates must possess a BSN and an active RN...

Description As an RN Care Manager, you will function as a clinician, advocate, and educator to achieve optimal clinical and quality outcomes by effectively managing care and resources to reduce unnecessary utilization. The RN...

Registered Nurse Explore opportunities with [agency name], a part of LHC Group, a leading post-acute care partner for hospitals, physicians and families nationwide. As members of the Optum family of businesses, we are dedicated to helping...