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RN - Utilization Review Nurse | 3+ Years of Experience | Remote in IL | Contract Walker Healthforce is seeking a RN - Utilization Review Nurse with 3+ Years of Experience to support a Healthcare Payor Client based out of IL.

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...

Fully Remote: Clinical Documentation Specialist Facilitate the improvement of clinical documentation by collaborating with physicians, nursing staff, and other patient caregivers. Perform concurrent and retrospective reviews of medical...

Join Martin's Point Health Care - an innovative, not-for-profit health care organization offering care and coverage to the people of Maine and beyond. As a joined force of "people caring for people," Martin's Point employees are on a mission to...

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...

City/State Norfolk, VA Work Shift First (Days) Overview: Sentara Health is currently hiring for a Utilization Review Nurse- Remote in VA! Status: Full-time, permanent...

A prominent health company is seeking a Transitions of Care RN for virtual delivery of patient education and health coaching across various disease management programs. This role requires at least an Associate's degree in nursing and a current 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 Care Manager...

Job Type Full-time Description Gateway Rehab Center (GRC) has an outstanding opportunity for a Nurse Liaison Gateway Rehab who will be responsible for the pre-admission case management, ASAM level of care assessment, and...

Job Description Under broad direction from the Centralized Utilization Management Manager, is responsible for the hospital-wide Utilization Management Programs in a general acute care hospital which serves infant, pediatric,...

The position is work from home with field visits. JOB PURPOSE: This position is responsible for conducting medical management and health education programs for customers on government health care programs. Accountabilities include...

Join Our Caring Community: Help Us Prioritize Health The Pre-Authorization Nurse Specialist is responsible for reviewing prior authorization requests to ensure appropriate care and settings, adhering to established guidelines and...

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...

Become a part of our caring community and help us put health first Healthcare isn't just about health anymore. It's about caring for family, friends, finances, and personal life goals. It's about living life fully. At...

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...

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...

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data...

Are you looking to work for mission driven and passionate warriors like yourself? Looking to grow within an organization? The Company: We are Ohana Pacific Health. We positively impact thousands of lives each year...

A healthcare staffing company is seeking a Registered Nurse in Columbia, SC for a 3-month assignment with potential for conversion. The role includes evaluating medical eligibility for benefits, providing health management interventions, and...

Medical Child Abuse Nurse Consultant (0.6FTE, Limited Term) Provides operational, quality improvement, and management consulting services. Plans implements, and evaluates projects related to system development, operational and strategic...

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...

Remote Clinical Review Nurse Prior Authorization Location: Must be located in Central or Eastern time zones Employment Type: Full?Time About the Role We are seeking an experienced Registered Nurse to join our team...

Description Join PeaceHealth in advancing compassionate, mission-driven care from wherever you are. PeaceHealth is looking for a skilled and motivated Registered Nurse Utilization...

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...

divh2RN Care Review Clinician/h2pThe RN Care Review Clinician provides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and align with established clinical...