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CVS Aetna Appeals Nurse Consultant 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...

The IMA Group is seeking a Registered Nurse (RN) to join our Payer Services division as a Clinical File Review Specialist. This role is ideal for nurses looking to transition away from bedside care into a fully remote,...

Details Client Name PIH HEALTH Job Type Travel Offering Nursing Profession Registered Nurse Specialty...

Summary VA Greater Los Angeles Healthcare System (VAGLAHS) is seeking to hire experienced Registered Nurses to work in our Case Management/Care Coordination Program. The Case Manager provides patient centered care with expertise in 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,...

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...

The Case Management Utilization RN works collaboratively with physicians to coordinate patient admissions and discharges, ensuring appropriate levels of care and compliance with regulations. This role is ideal for those who excel in a fast-paced...

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,...

Job Title Conducts admission concurrent and retrospective case reviews to ensure appropriate admit status and level of care by utilizing the nationally approved guidelines. Collaborates with medical staff and ancillary hospital...

Claims Medical Review Nursing Consultant Job No: 544045 Work Type: Full-time Location: REMOTE OPTIONS, VARIOUS-STATEWIDE, PHOENIX Categories: Healthcare/Medical Support Level,...

Why This Role Matters Every determination you make decides whether a member gets the care they need, when they need it. This role sits at the exact point where clinical judgment meets real-world impact, translating evidence-based criteria...

Please make sure to complete all the questions in the application and continue through to the end in order to sign and submit it. The preferred work hours are 8:30 am / 9 am - 5 pm / 5:30 pm central time...

Regional Nurse Consultant RN StoneGate Senior Living in Tulsa, OK is hiring a Regional Nurse Consultant RN for our Tulsa, OK region. A rewarding career is waiting for you at a great facility that specializes in long-term and...

Job Title Real Job *Works with any department, if a patient complaint arises* *Experience in Critical Care or ED is a plus* *Weekends will not typically be required unless survey is on site* *2 years experience required, hard stop* *First...

Utilization Management Nurse Consultant Clinical Precertification RN (Medicare Home Care) Remote | Full-Time | Weekday Schedule Are you a Registered Nurse ready to make an impact beyond the bedside? Join our team and use your...

Job Title This is a remote position but will need onsite training in Mishawaka Indiana. Shift: Days - 8 hr shift LOCAL CANDIDATES ONLY! Why Choose Saint Joseph Health System? At Saint Joseph Health System, our values guide...

SHIFT: Any (United States of America) Seeking Breakthrough Makers Children's Hospital of Philadelphia (CHOP) offers countless ways to change lives. Our diverse community of more than 20,000 Breakthrough Makers will...

Infection Preventionist Nurse - Acute Care is an exciting opportunity to lead infection prevention initiatives at a respected Southern California medical center. The Infection Preventionist Nurse - Acute Care will advance patient...

RN Utilization Review Review patient medical records to assess the appropriateness and medical necessity of hospital admissions, continued stays, and services, while coordinating with providers and payers to ensure compliance with...

*NURSING AT CHILDREN'S HOSPITAL LOS ANGELES* As a nurse, you approach care with energy and resolve. When you join us, you'll find the perfect environment to develop your nursing career. We stop at nothing to make sure that every patient we see...

HSS Clinical Coordinator RN At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the...

UM Review Nurse - Texas Astrana Health is looking for a Utilization Review Nurse with a Texas LVN license to assist our Health Services Department in reviewing a high volume of outpatient and inpatient cases. This position will require...

Private Health Management, Inc. is seeking a Nurse Advisor on the Health Advisory team to guide clients through the healthcare system, educate them, advocate for quality care, and coordinate services. You will support PHM's triage team and place...

Remote, USA Remote, GA Remote, MS Remote, OH Remote, NC Remote, TN Remote, AR Remote, TX Remote, KY Remote, AL Remote, IN Full time R260000007933 At R1, we're...

Jobgether, on behalf of a partner company, is seeking a Case Manager – Utilization Review Specialist for a remote US-based position. The role focuses on admission and concurrent reviews, denials prevention, and appeals support, leveraging...