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Overview The challenges of affordable healthcare continue to create new opportunities. Elderplan and HomeFirst, our Medicare and Medicaid managed care health plans, are outstanding examples of how we are expanding services in...

A leading health insurance provider is seeking a Managed Care Coordinator I to join their team. This fully remote position requires you to review and evaluate medical eligibility regarding benefits and clinical criteria. Candidates must have an...

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...

Description Location: UCHealth Anschutz Inpatient Pavilion - Aurora Department: Virtual Health Center - Quality program This position is an onsite role and does not offer a hybrid or remote option Work Schedule: Full Time, 72.00 hours per pay...

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...

JOB DESCRIPTION Job Summary Provides support for medical claim and internal appeals review activities - ensuring alignment with applicable state and federal regulatory requirements, Molina policies and procedures, and medically...

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...

A healthcare organization in Washington, DC, is seeking a qualified nurse for clinical review and care coordination. This role requires evaluating medical services and ensuring effective patient care while maintaining communication with various...

The Nursing Home Administrator provides leadership and direction for overall facility operations to provide quality patient care in accordance with all laws, regulations, and Life Care standards. Your duties will including overseeing key areas...

What You'll Do: The Ohio Department of Health / Complex Medical Help program is looking for an experienced nursing leader to oversee statewide public health nursing programs, guide policy development and ensure consistent,...

A healthcare innovator in California is seeking a Registered Nurse to provide remote care as part of a telehealth team. Responsibilities include conducting assessments, educating patients, and ensuring compliance with healthcare regulations.

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...

Description Join PeaceHealth in advancing compassionate, mission-driven care from wherever you are. PeaceHealth is looking for a skilled and motivated Registered Nurse Utilization...

Requirements Qualifications / Experience Current multi-state RN license with no restrictions; nurses currently holding a single-state RN license must obtain a multi-state license prior to being made a job...

Dept: Quality and Provider Ed ****Looking for a registered nurse in the Grand Rapids or northern Michigan (lower peninsula) area. Most work will be remote from home and/or traveling, however, there are occasions contractor will need to...

A prominent healthcare provider is seeking a Nurse Reviewer I for a virtual position responsible for conducting reviews of diagnostic imaging services. The ideal candidate should possess an AS in nursing and clinical nursing experience, alongside...

Job Description Are you a registered nurse ready to take your career in an exciting new direction-one where your expertise truly makes a difference? Join Pennsylvania's premier Quality Improvement Organization and step into a...

Carries out communicable disease surveillance, prevention, and control measures for the City of Boston. Investigates reports of communicable diseases including pathogens of public health importance, reported outbreaks, or other...

HJ Staffing is partnering with Impresiv Health, a specialized healthcare consulting partner, to find a dedicated and detail-oriented Utilization Management Registered Nurse (UM RN). This critical...

Clinical Research RN Days Shift Monday to Friday Urology Research Royal Oak, MI Scope of Work Join our team to support leading-edge research with a team of renown physicians. Urology Research has...

The VITAS Telecare RN is a member of the interdisciplinary team who is the pivotal person responsible for identifying the physical, psychological, social, and spiritual needs of those patients and families needing assistance after normal business...

A leading healthcare organization is seeking a Prior Authorization RN to join its team. This role entails reviewing prior authorization requests to ensure medical necessity and compliance with Medicare and Medicaid guidelines. Applicants should...

Overview What you can expect! Find joy in serving others with IEHP! We welcome you to join us in healing and inspiring the human spirit and to pivot from a job opportunity to an authentic...

Company Overview Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact. Lead the Way is our...

Job Description: • Participates in the development and ongoing implementation of QM Work Plan activities. • Improve quality products and services, by using measurement and analysis to process, evaluate and make recommendations to meet...