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Guidehealth is seeking a Registered Nurse (RN) for a remote Telehealth Medicare Annual Wellness Visit Specialist - PRN. The role conducts AWVs via telehealth under physician supervision, focusing on preventive care and patient education.

Kingman Healthcare Incorporated (KHI)Staff Position Description Position Title: Utilization Review Nurse Position Code: RN-6027 Department: Case Management Safety Sensitive: Yes...

Oscar Health is seeking a Utilization Review Nurse to join our team. You will review cases, verify medical records, and consult with care providers to assess treatment appropriateness using Oscar Clinical Guidelines, MCG, and InterQual. The...

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...

Job ID: Posted: Location: Eden Prairie, Minnesota, United StatesSalary: $91,700 - $163,700/yearJob Area: Medical & Clinical OperationsCompany: UnitedHealth GroupOptum is a global organization that delivers care, aided by technology to help...

AmeriPharma is seeking a Parenteral Services Clinical RN Specialist to provide advanced nursing expertise, care coordination, education, and operational collaboration. The role supports nurses, pharmacists, dietitians, and care coordinators to...

Get AI-powered advice on this job and more exclusive features. This range is provided by The Judge Group. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more. Base pay range...

Leveraging clinical expertise, the fully remote Multi Benefit Services RN Consultant in Wisconsin will review Medicaid prior authorization requests, determine medical necessity, and support providers while ensuring compliance with state policy...

Type: Clinic Somerville , MA SkyBridge Healthcare is currently seeking Registered Nurse with Clinic experience for a 13-week contract in MA. SkyBridge Healthcare is a premier staffing firm dedicated to matching outstanding talent...

CVS Health is seeking a licensed RN Case Manager to work remotely across the United States, conducting telephonic case management for fully insured and self-insured clients with clinical judgment and collaboration with care teams. The role...

Santa Barbara Cottage Hospital is seeking a QIC Part A Nurse Consultant for a remote six-month assignment. The role focuses on reviewing determinations and rendering medical necessity decisions for Medicare State East cases, while resolving...

BlueCare | Clinical Nurse Consultant | Community Care Employment Status: Full time - 6 Month Fixed Term Contract Location: Network A scope – Remote Support, some travel across Network may be required (North QLD - Mackay to...

BCBST BlueCross BlueShield of Tennessee, Inc. is hiring an Appeals & Grievance Nurse Analyst to review and process member and provider appeals, ensuring timely and compliant resolutions under CMS, Medicare, and TennCare guidelines. The role...

CVS Health is seeking an experienced Utilization Management Nurse Consultant for a fully remote role across EST or CST zones. You will coordinate and document UM activities, ensuring safe, appropriate care and adherence to timelines while working...

Guidehealth in the United States seeks an experienced RN Case Manager to work remotely with Illinois licensure. You will oversee member management, promote wellness, and support cost-effective care within a value-based care framework.

A healthcare staffing company is seeking a Clinical Review Nurse for Prior Authorization Review. This remote role demands conducting reviews, collaborating with healthcare teams, and ensuring compliance. Candidates need an active RN license and...

Evry Health seeks an RN Integrated Care Coordinator (UM) to provide comprehensive care coordination and drive quality outcomes for members across the care continuum. This remote role requires rotating weekend hours for utilization review and...

Nurse Consultant/ Regional Director Of Clinical Operations Relocation to Southern New Mexico is required. The Nurse Consultant/ Regional Director of Clinical Operations position is comprised of two essential objectives; to partner...

A leading health company is seeking a remote RN Case Manager responsible for assessing and coordinating case management activities for members. Candidates must possess an active RN license and have at least 3 years of acute care experience. Strong...

Relocation to Southern New Mexico is required. The Nurse Consultant/ Regional Director of Clinical Operations position is comprised of two essential objectives; to partner with facilities as the primary clinical resource in...

Utilization Review Nurse - RN | 100% Remote | Part-Time 10-20 Hours Per Week | Flexible Schedule | Evenings & Weekends Looking for a way to use your nursing experience without returning to a full-time bedside...

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...

Santa Barbara Cottage Hospital is seeking an experienced RN/LPN to perform remote clinical reviews for appeal cases. You will review medical records, apply InterQual criteria, and prepare clinical determinations for physician review. The...

Opco-Skilled-Management- is seeking a Central Intake Nurse to coordinate initial and ongoing referral documentation from physicians, insurers, and providers to determine service appropriateness and facility placement. You will develop patient care...

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...