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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...

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...

Description RN Utilization Review at Irvine, CA. This position is Part- time and will work Remote 8-hour, Day shifts. Provide prospective, retrospective, and concurrent utilization reviews for our...

A leading healthcare company is seeking a Utilization Management Nurse 2 to leverage clinical knowledge and communication skills in providing optimal care for members. The role involves coordinating with providers and interpreting clinical...

Baptist Health is the regions largest not-for-profit healthcare organization, with 12 hospitals, over 28,000 employees, 4,500 physicians and 200 outpatient centers, urgent care facilities and physician practices across Miami-Dade, Monroe, Broward...

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...

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...

The RN Case Manager is responsible for coordinating continuum of care activities for assigned patients and ensuring optimum utilization of resources, service delivery, and compliance with medical regime. Essential Duties and...

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...

Registered Nurse Case Review Specialist Position is Remote/Nationwide Job Summary STGi is currently seeking a Registered Nurse Case Review Specialist. The position is remote and open to candidates nationwide. Provides direct...

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,...

Description As an RN Care Manager, you will function as a clinician, advocate, and educator to achieve optimal clinical and quality outcomes by effectively managing care and resources to reduce unnecessary utilization. The RN Care Manager...

A leading health care organization in Virginia is seeking a qualified Registered Nurse to handle HCBS authorizations and collaborate with providers. This role requires active RN licensure and at least three years of experience in an acute setting.

In order to have an accurate count of participants, we need you to register for the Recruitment Fair on the District's website. Please select "apply for this position" under the heading to the right labeled "Apply Now". Interviews slots will fill up...

By joining Sedgwick, you'll be part of something truly meaningful. It's what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture,...

Clinical Documentation Improvement (CDI) Specialist Registered Nurse (RN) When you join the growing BILH team, you're not just taking a job, you're making a difference in people's lives. This position is remote. Candidates must be local...

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...

DEPARTMENT: 18400 - Medical Staff LOCATION: 350 7th Street North, Naples, FL, 34102 WORK TYPE: Full Time WORK SCHEDULE: 8 Hour Day ABOUT NCH NCH is an...

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...

A leading health solutions company is seeking a Care Manager-Registered Nurse in Connecticut. This role requires developing and coordinating care plans for members with multiple chronic conditions while ensuring effective telephonic engagement.

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...

We've made a lot of progress since opening the doors in 1942, but one thing has never changed - our commitment to serve, heal, lead, educate, and innovate. We believe that every award earned, every record...

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...

A leading healthcare provider seeks a Utilization Management Specialist to assess patient admissions, ensuring compliance with appropriate care standards. The role requires collaboration with internal teams and may involve a signing bonus. A...

Job Description Under broad direction from the Centralized Utilization Management Manager, is responsible for the hospital-wide Utilization Management Programs in a general acute care hospital which serves infant, pediatric,...