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Resp & Qualifications PURPOSE: The Clinical Appeals Nurse completes research, basic analysis, and evaluation of member and provider disputes regarding adverse and adverse coverage decisions. The...

Become a part of our caring community and help us put health first The Pre-Authorization Nurse 2 reviews prior authorization requests for appropriate care and setting, following guidelines and policies, and approves services...

Overview Ensuring Compliance. Streamlining Authorizations. Supporting Patient Care. The Clinical Authorization Nurse plays a key role in supporting our authorizations department by reviewing clinical...

A healthcare consulting firm is seeking a Clinical Lead Consultant to join their team in Toledo, Ohio. This full-time, remote role involves consulting services for nursing facilities and includes responsibilities like MDS completion, auditing, and...

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 global healthcare service provider is seeking a Remote RN to provide pharmacy utilization management services, focusing on patient safety and quality standards. Candidates should have a Bachelor's degree in Nursing and an active RN...

Job Type Full-time Description Gateway Rehab Center (GRC) has an outstanding opportunity for a Nurse Liaison Gateway Rehab who will be responsible for the pre-admission case management, ASAM level of care assessment, and...

Join Martin's Point Health Care - an innovative, not-for-profit health care organization offering care and coverage to the people of Maine and beyond. As a joined force of "people caring for people," Martin's Point employees are on a mission to...

A healthcare organization in Atlanta, Georgia is seeking a Registered Nurse (RN) to create care plans and perform evaluations for clients. Responsibilities include reviewing charts, ensuring quality care, and communicating with various...

Medical Child Abuse Nurse Consultant (0.6FTE, Limited Term) Provides operational, quality improvement, and management consulting services. Plans implements, and evaluates projects related to system development, operational and strategic...

Current Employees: If you are currently employed at any of the Universities of Wisconsin, log in to Workday to apply through the internal application process. Job Category: Academic Staff...

Description & Requirements Be part of something great Maximus is a global organisation that specialises in providing health and employment services to millions of people every year. Here in the UK we employ...

Location Address: Remote Office , Santa Fe, New Mexico 87501, United States of America Compensation Pay Range: Minimum Offer $: 27.92 Maximum Offer for this position is up to $: 42.63...

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation's leading health solutions company, we reach millions...

Job Type Full-time Description Job Summary The Utilization Review (UR) Nurse is responsible for analyzing medical records for medical-legal reviews and producing high-quality, professional executive...

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A leading healthcare provider is urgently seeking experienced Clinical Documentation Specialists for remote positions. Ideal candidates must be RN graduates from an approved nursing program and possess prior CDI experience, preferably in acute...

Ampcus Inc. is a certified global provider of a broad range of Technology and Business consulting services. We are in search of a highly motivated candidate to join our talented Team. Job Title: Clinical Medical Review Nurse.

A leading risk and claims management firm is seeking a part-time nurse in Oklahoma City. This role involves triaging calls and assessing the needs of clients to provide appropriate care advice. Candidates must possess an active RN license, a BSN...

$40/hour - Contract for 6 months Must reside in TX Full time remote Candidates must be based in TX. RN working in the insurance or managed care industry using medically accepted criteria to validate the medical...

HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the...

Pre-Access Utilization Management Registered Nurse Insight Global is looking for a Pre-Access Utilization Management Registered Nurse to sit remotely with one of their large health insurance clients. This person will be responsible for...

Nursing Facility Service Coordinator - Kutztown area - Remote Join to apply for the Nursing Facility Service Coordinator - Kutztown area - Remote role at Amcord Care Inc. Job Overview The...

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...

Job Description JOB CATEGORY: REGISTERED NURSE / COMMUNITY HEALTH CENTER / WELLNESS REMOTE ELIGIBLE AFTER 90 DAYS POSITION SUMMARY: This position works directly...