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Clinical Appeals and Grievances (analyzing, reviewing appeals/grievances)Clinical Interface/ Liaison (clinical problem solver with facilities, providers, resolution of issues concerning members, program definition and clarification)Clinical...

Current Employees: If you are a current Staff, Faculty or Temporary employee at the University of Miami, please click here to log in to Workday to use the internal application process. To learn how to apply for a faculty or staff...

Immediate RN Clinical Consultant - ADA Medical Accommodation Review remote contract opportunity. This is a 100% remote/work from home position. Pay Rate: $85.00/hr Work Details: ...

Registered Nurse - Case Review Specialist STGi is currently seeking a Registered Nurse-Case Review Specialist. The position is remote and open to candidates nationwide. Job Summary: Provides direct support...

Registered Nurses are encouraged to consider a part-time remote Nurse Reviewer position with Liberty Healthcare Corporation. Liberty Healthcare operates a statewide program in Idaho which assesses children and adults who are living with...

A healthcare provider is seeking a Registered Nurse for care management coordination in Salt Lake City, UT. This role involves assessing member needs, developing care plans, and facilitating interdisciplinary collaboration. Candidates should have...

Job Description JOB SUMMARY Responsible for reviewing medical records to facilitate and obtain appropriate physician documentation for any clinical conditions or procedures to support the appropriate...

A healthcare insurance provider is seeking a qualified individual for a clinical oversight role in Phoenix, AZ. The position requires significant clinical experience, including work with Medicaid/Medicare, and offers a hybrid work model.

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.

A leading health solutions company is seeking a Care Manager-Registered Nurse in Connecticut. This role requires developing and coordinating care plans for members with multiple chronic conditions while ensuring effective telephonic engagement.

divh2Director of Nursing/h2pInniswood Village located in Westerville, OH is an independent living, assisted living and memory care community with a team of health care professionals that is unmatched in the area!/ppWe are owned and operated by...

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...

We believe everyone should have confidence in navigating their healthcare. We are looking for a qualified Registered Nurse (RN) to serve our patient population in the navigation, prevention and management of their health through continuous care...

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...

JOIN TEAM TRILOGY: At Trilogy, you'll experience a caring, supportive community that values each team member. We prioritize meaningful relationships, genuine teamwork, and continuous growth. With the stability of...

Nurse Manager The Ohio State University Medical Centers mission is focused on integrating quality patient care, education, and research; the Nurse Manager leads a team of professional health care providers cultivating collaboration,...

This position is fully remote, however, you must reside in the State of Texas The position is a contract for about 6 months. RN working in the insurance or managed care industry using medically accepted criteria to validate the...

A healthcare technology firm is seeking a Nurse Consultant with experience in adult health. This hybrid position involves creating detailed patient medical records and building relationships with providers. Ideal candidates possess at least three...

ChenMed is seeking a Registered Nurse (RN) Educator for a nursing job in Columbus, Ohio. Job Description & RequirementsSpecialty: EducatorDiscipline:...

RN Clinical Appeals Nurse Job Summary: The RN Clinical Appeals Nurse provides support for internal appeals clinical processes - ensuring that appeals requests are reevaluated in alignment with applicable federal and state regulatory...

Deep Roots. Solid Growth. Caring People. Rooted in Wyoming! We are Blue Cross Blue Shield Wyoming: a not-for-profit health insurer with offices throughout the state. Ever since a small group of caring,...

Become a part of our caring community and help us put health first Humana is seeking a Prior Authorization RN to join the Wisconsin Medicaid Market (iCare) team. This position reviews the clinical appropriateness of prior...

Quality Assurance Position Contract-to-hire details and pay: $34/hr for a 520-hour contract-to-hire, long term opportunity. Compensation: listed below, fixed rates (no opportunity for negotiation). Training schedule: MondayFriday, 46...

Quality Assurance Position Contract-to-hire details and pay: $34/hr for a 520-hour contract-to-hire, long term opportunity. Compensation: listed below, fixed rates (no opportunity for negotiation). Training schedule: MondayFriday, 46...

We are so glad you are interested in joining Sutter Health! Organization: SHSO-Population Health Services-Utah Position Overview: The Virtual Mental Health Intake RN is a Registered Nurse who provides competent and...