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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...

Sentara Health Plans seeks a Clinical Claims Reviewer RN for remote work. You will perform utilization management, review pre/post payment claims and authorizations for inpatient/outpatient cases, and address provider inquiries with appropriate...

Job Summary and ResponsibilitiesAs our Educator in Critical Care Emergency, In accordance with our mission and core values of integrity, compassion, collaboration, and excellence, this position is established to serve as a consultant/resource...

Actalent is seeking an experienced Utilization Review RN for a remote MondayFriday opportunity with a CA-based license requirement. The role reviews clinical information, applies criteria, and makes first-level recommendations to ensure regulatory...

Health Care 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 deeply,...

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process. Clinical Reviewer RN - Alabama Alabama, US 30+ days ago Requisition...

About This Role As an Inpatient Care Management Nurse, you will be responsible for ensuring proper utilization of health services by assessing and interpreting member needs and identifying solutions to help members live healthier lives.

Jobgether, on behalf of a partner organization, seeks an experienced Registered Nurse for a remote Utilization Management role. You will review cases, assess medical necessity, and support prior authorization decisions while collaborating 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...

Exceptional care starts with exceptional people. For us, this is more than a job- it's a calling. It's waking up each day, looking for ways to make a difference with a compassionate, inclusive and talented team. Ochsner empowers you to...

American Health Plans Franklin, TN 37067, USA Description American Health Plans, a division of Franklin, Tennessee-based American Health Partners Inc. owns and operates Institutional Special Needs Plans (I-SNPs) for seniors...

This is a fully remote position, open to candidates based in United States. Pay: $60–$70/hr Role Title: Registered Nurse Role Type: Contractor Location: United States,...

Sagility combines industry-leading technology and transformation-driven BPM services with decades of healthcare domain expertise to help clients draw closer to their members. The company optimizes the entire member/patient experience through...

Our client, a Health Insurance company, is looking for a Registered Nurse-Review Analyst for their Remote location. Responsibilities: Perform prospective, concurrent, and retrospective review of inpatient,...

American Health Plans, a division of Franklin, Tennessee-based American Health Partners Inc. owns and operates Institutional Special Needs Plans (I-SNPs) for seniors who reside in long-term care facilities. In partnership with nursing home...

Humana is seeking a Utilization Management Registered Nurse to interpret and support coordination, documentation and communication of medical services and benefit determinations for post-acute care services including SNF, home health and DME.

It takes great medical minds to create powerful solutions that solve some of healthcare's most complex challenges. Join us and put your expertise to work in ways you never imagined possible. We know you've honed your career in a fast-moving...

This position will be paying $26.50/hr for an LPN and $28.50/hr for an RN Job Description The Clinical Quality Assurance Coordinator is responsible for ensuring case reports are of the highest quality and integrity and in full...

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

VitaCare Living in Spooner, WI is seeking an experienced Registered Nurse (RN) Consultant to provide clinical oversight for our assisted living and memory care communities. You will guide practice, ensure regulatory compliance, and support staff...

Public Consulting Group LLC (PCG) is a leading public sector solutions implementation and operations improvement firm that partners with health, education, and human services agencies to improve lives. Founded in 1986, PCG employs approximately...

Location: Fully remote. Description: Our client is seeking an experienced Concurrent Review Registered Nurse (RN) to join its Utilization Management team. In this role, you will perform concurrent...

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process. Director Nursing Practice & Workforce Solutions (Remote) EDUCATION &...

It takes great medical minds to create powerful solutions that solve some of healthcare's most complex challenges. Join us and put your expertise to work in ways you never imagined possible. We know you've honed your career in a fast-moving...

To support home health services, the full-time Nevada Licensed Clinical Nurse Consultant will create and evaluate educational programs, lead staff development activities, and monitor quality of patient care while working remotely from anywhere in...