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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...

JOB DESCRIPTION Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and...

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

CVS Health is hiring a full-time RN for healthcare services and utilization management. The role emphasizes assessing and coordinating care, applying clinical criteria, and communicating with providers to optimize member outcomes. The...

Alignerr is seeking a Nursing Informatics Specialist (AI Training) who brings clinical nursing expertise to evaluate and improve AI systems used in healthcare settings. Remote, hourly contract with flexible hours (10-40 hours/week), focusing on...

Jushi Holdings Inc. seeks a Medical Professional to deliver patient consultations and guidance on medical cannabis within a compliant, patient-first framework. The role emphasizes HIPAA-compliant care, accurate information, and collaboration with...

Immediate need for a talented Utilization Management RN - Prior Authorization. This is a 12+ Months Contract opportunity with long-term potential and is located in US (Remote). Please review the...

Serving as the strategic quality advisor for a portfolio of Value-Based Care organizations, the full-time Lead VBC Quality Consultant will analyze performance, develop quality improvement strategies, and partner with provider organizations to...

Jushi Holdings Inc. seeks a Medical Professional to deliver patient consultations and guidance on medical cannabis within a compliant, patient-first framework. The role emphasizes HIPAA-compliant care, accurate information, and collaboration with...

Amerit Consulting is seeking an experienced Utilization Management Nurse (RN) in California for a remote 6-month contract. The incumbent will support inpatient utilization review, medical necessity determinations, and facility claims compliance,...

Jobgether is seeking a Coding Consultant Outpatient – PRN based in the United States. This remote, part-time role focuses on accurate outpatient coding, review of documentation, and ensuring proper APC and reimbursement details. The...

Resp & Qualifications We are looking for an experienced professional to work remotely from within the greater Baltimore metropolitan area. The incumbent will be expected to come into a CareFirst location periodically for...

CVS Health in Oklahoma is seeking an experienced Utilization Management Nurse Consultant (RN) for a 100% remote role based in Oklahoma. You will review medical necessity, coordinate care, support discharge planning and provide coverage...

CVS Health is seeking a registered nurse to assess, plan, implement, coordinate and evaluate healthcare options for members. The role focuses on coverage determination and coordination within the utilization management framework. The...

Cabell Huntington Hospital is seeking a casual, as needed Virtual Integrated Care Coordinator (RN) for our CHH Virtual Integrated Care Department. This job is responsible for supporting and...

CVS Health is seeking a Nurse Consultant for Utilization Management in a 100% remote capacity. The role reviews inpatient and outpatient services using evidence-based criteria, authorizes care with providers, and escalates cases as needed.

JOB DESCRIPTION We are searching for six TX licensed RNs to work telephonically with our Medicaid members across the state. Three of the positions are open to RNs with at least two years of experience in in Behavioral Health or Substance...

Sedgwick is hiring for a Clinical Consultation Triage Nurse in a remote, full-time role. You will triage calls, assess needs, and provide care guidance to determine the appropriate level of care, while supporting return-to-work goals. The...

The Virtual Nurse, RN at MUSC coordinates and delivers professional clinical, quality, and educational services to patients engaging with MUSC via virtual care. This role reports to leadership within the MUSC Center for Telehealth and aims to...

Centene Corporation is seeking a Licensed Practical Nurse (LPN) or Registered Nurse (RN) for a remote case management role in Pennsylvania. The selected candidate will perform concurrent reviews, determine appropriate care levels, and assist with...

The North Carolina Department of Health and Human Services (DHHS) seeks a Nurse Consultant II (NS) in the Immunization Branch. The role delivers high‑level clinical guidance, conducts VFC site visits, and ensures nursing policies align with...

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...

CVS Health is seeking a Registered Nurse for Utilization Management to assess and coordinate healthcare services for members, applying clinical judgment and guidelines to render coverage decisions. Collaboration with providers supports care...

Harborview Medical Center is seeking a Tele Forensic Nurse Examiner (TFE) for the FNE/SANE Program. This fully remote role supports forensic examinations across Washington State, with case reviews and QA meetings on a regular cadence. The...