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JOB DESCRIPTION We are searching for six TX licensed RNs to work telephonically with our Medicaid members across the state. Three of the positions are open to RNs with at least two years of experience in in Behavioral Health or Substance...

Job Summary: Collaborates with Education Consultants, Managers, CNS staff and Physicians to develop, design, deliver and evaluate/improve education strategies and special projects/programs based on clients departmental...

HealthHelp, a WNS company, seeks a Clinical Review Nurse for a fully remote role in the United States. You will perform prospective reviews for medical necessity on prior authorization requests across multiple specialty programs and refer...

Our client, a mutual benefit corporation and health plan provider, seeks an accomplished Registered Nurse (Utilization Management) .Candidate must be authorized to work in USA without requiring sponsorshipLocation: 100% Remote for California...

CVS Health is seeking a Registered Nurse for Utilization Management to assess and coordinate healthcare services for members, applying clinical judgment and guidelines to render coverage decisions. Collaboration with providers supports care...

Cabell Huntington Hospital is seeking a casual, as needed Virtual Integrated Care Coordinator (RN) for our CHH Virtual Integrated Care Department. This job is responsible for supporting and...

JOB DESCRIPTION We are searching for six TX licensed RNs to work telephonically with our Medicaid members across the state. Three of the positions are open to RNs with at least two years of experience in in Behavioral Health or Substance Abuse...

Guardian Life is seeking an experienced RN Clinical Consultant to serve as a clinical expert supporting short-term and long-term disability claims. You will analyze medical information, assess functional capacity, and provide clinical guidance to...

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, innovate with purpose, hold...

The North Carolina Department of Health and Human Services (DHHS) seeks a Nurse Consultant II (NS) in the Immunization Branch. The role delivers high‑level clinical guidance, conducts VFC site visits, and ensures nursing policies align with...

Remote Nursing OpportunitiesAre you looking for an exciting way to utilize your nursing skills and expertise to deliver quality nursing care in a remote setting? AccessNurse, where technology meets compassionate care, is looking for professional...

Redesigning heart health via virtual cardiac rehab for older adults.Mission-driven team of clinicians and engineers.Responsibilities:Review EMRs to determine eligibility and create orders.Conduct video intake assessments and treatment...

What You'll Do As an Enrollment Nurse, your primary responsibility is enrolling patients in a chronic care management program. You'll call eligible patients, educate them about the program, answer questions, and assist interested patients...

Baptist Health is seeking a remote Clinical Documentation Specialist to evaluate physician documentation and ensure accurate illness severity portrayal for coding precision. The role requires an active Kentucky license and involves guiding...

Engage Consulting seeks an experienced MDS Nurse / MDS Coordinator for a full-time remote role supporting skilled nursing facilities with MDS assessments and reimbursement processes. The ideal candidate holds an active RN license with...

Patient Safety Infection Control Specialist RN - Dental Falls Church is an independent city in the Commonwealth of Virginia with a population of approximately 15,000. Falls Church is included in the Washington metropolitan area. Falls...

Comagine Health in Washington State is seeking an experienced registered nurse to join our remote clinical reviewer team. In this role you will assess medical necessity, appropriateness, and quality of care for Washington L&I contracts, applying...

Comagine Health is seeking a Clinical Reviewer (RN) remotely to support Washington state contracts. The role evaluates medical necessity and quality of care, collaborating with physician consultants and internal teams to ensure compliant,...

A technology and business consulting firm is seeking a Clinical Medical Review Nurse to analyze health data and provide insights for internal stakeholders. The ideal candidate has a Registered Nurse license, along with four years of clinical...

Managed Medical Review Organization seeks a licensed RN for a home-office, remote role focused on telephonic customer service and clinical documentation. The position emphasizes quality review, case management, and adherence to policy, with...

Registered Nurse Navigator - Cancer Center Exams - 10 Hour Days Do you have a passion for the highest clinical quality and patient happiness? Would you like to use your expert clinical competencies with an organization known nationally...

Remote Care Manager (RN) - MUST LIVE IN TEXAS TX, United States Trending Job Description JOB DESCRIPTION We are searching for six TX licensed RNs to work telephonically with our Medicaid members across the state.

Cambia Health Solutions is seeking an Appeals Clinician I who will work from home within Oregon, Washington, Idaho or Utah. You will leverage clinical expertise to complete the clinical component of all appeal types to resolve member/provider...

Performance Home Health is seeking an experienced Referral Review Nurse to join our growing team. This role reviews incoming home health referrals, ensures complete documentation, identifies missing information, and coordinates with multiple...

HBiz seeks a Clinical Appeals Nurse (RN) to remotely support revenue cycle operations. You will review denied claims for clinical accuracy, develop evidence-based appeal strategies, and draft payer-ready documentation to overturn denials and...