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Nurse - Clinical Review The Clinical Review Nurse makes prospective medical necessity determinations on prior authorization requests for HealthHelp's specialty programs, including Diagnostic Imaging, Cardiology, Musculoskeletal, Physical...

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...

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...

Clinical Nurse Consultant At Bristol Myers Squibb, our employees often ask, "Who are you working for?"—a question that fuels collaboration, accountability, and urgency in our work. Our purpose-driven culture inspires us to discover,...

PIH Health in Los Angeles is seeking an RN Peer Review Analyst responsible for retrospective medical record reviews, data compilation to validate quality and accuracy of documentation, and auditing charts for admission/continued stay. You will...

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,...

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...

Job Title 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...

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...

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...

*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...

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...

CVS Health Nursing Position 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...

Clinical Integrity Documentation Specialist Location: Remote Facility: Ascension Wisconsin Hospitals Department: Clinical Integrity Documentation Schedule: Days | Full-Time Salary Range: $79,511.52-$110,834.59...

Job Summary: Provides consultation and leadership in designated areas of expertise independently. Collaborates with interdisciplinary teams and stakeholders to address issues and achieve project objectives. Coordinates...

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...

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...

Utilization Management 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...

*Job Summary and Responsibilities* As our Nurse Shift Manager, you'll oversee a department of frontline nurses caring for patients. Every day you will advocate for your fellow nurses as you support them in reaching their full potential,...

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

Utilization Management Registered Nurse (RN) - Remote Full-time WHO IS GUIDEHEALTH? Guidehealthis a data-powered, performance-driven healthcare company dedicated to operational excellence. Our goal is to...

At Virtua Health, we exist for one reason - to better serve you. That means being here for you in all the moments that matter, striving each day to connect you to the care you need. Whether that's wellness and prevention, experienced specialists,...

Job Description The Peer Review RN is responsible for facilitating the design, implementation and the ongoing evaluation of the physician peer review program and nursing peer review process in collaboration with physician...

Agency Dept of Health and Human Services Division Health Service Regulation Job Classification Title Nurse Consultant II (NS) Position Number 65026151 Grade MH17...

Registered Nurse - Review Analyst | Remote | Contract Walker Healthforce is seeking a Registered Nurse - Review Analyst with 2-4 years of clinical experience to provide clinical utilization reviews, evaluate medical...