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Nurse Reviewer Appeals and Hearings- Remote 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...

First Connect Health is seeking a travel nurse RN Cardiac Cath Lab for a travel nursing job in Los Angeles, California. Job Description & RequirementsSpecialty: Cardiac...

Please contact: To discuss this amazing opportunity, reach out to our Talent Acquisition Specialist Nikhil Jhajharia at email address [email protected] can be reached on # 630-576-1935. We have...

Pacificare Health Management is seeking a Nurse Consultant in Los Angeles, CA to provide support for long-term care facilities, ensuring compliance with regulatory standards. The role requires a Bachelor's degree in Nursing, with at least 5 years...

Registered Nurse Sanford Health, the largest rural health system in the United States, is dedicated to transforming the health care experience and providing access to world-class health care in America's heartland. The Center for...

RN Clinical Documentation Improvement Specialist This is a REMOTE opportunity Your experience matters: Frye Regional Medical Center, located in the beautiful foothills of North Carolina is a 355-bed acute care hospital,...

Utilization Management 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...

Complex Medicare Claims Review Complex Medicare claims/prior authorization requests require the review of medical record documentation to determine the reasonableness and necessity of the billed service in accordance with Medicare rules...

Nurse Consultant I (NS) The North Carolina Department of Health and Human Services (DHHS) is one of the largest, most complex agencies in the state, and has approximately 17,000 employees. It is responsible for ensuring the health,...

City/State Norfolk, VA Work Shift Multiple shifts available Overview: Sentara Health Plansis hiring a Clinical Compliance Consultant/LPN/RN/LCSW/LPC - Remote in Virginia! Status:...

Are you our next Change Agent? We are seeking a compassionate and experienced Patient Support Program (PSP) Nurse to deliver exceptional, one-on-one support to patients navigating their treatment journey. You will be part of...

JOB DESCRIPTION Nestled between Burbank and Pasadena, Adventist Health Glendale is one of the area's leading healthcare providers. We are comprised of a 515-bed hospital, two urgent cares, home care services, comprehensive cardiology...

Description: The Organization San Gabriel/Pomona Regional Center (SG/PRC) is a private, nonprofit agency contracted with the California Department of Developmental Services (DDS) to provide services and...

Location Address: 2925 Chicago AveLoading DockMinneapolis, MN 55407-1321 Date Posted: June 15, 2026 Department: 16007317 System Complex Care Management Shift: Day (United States of America)...

RN Health Care Facility Surveyor - Washington Impact Recruiting Solutions is currently seeking a RN Health Care Facility Surveyor to fill an opening with a Quality Improvement Consulting Company and will work in a technically exciting...

Clinical Utilization Review Nurses (RN) Based In Alabama Comagine Health is a national, mission-driven, nonprofit organization that has engaged in health care quality consulting and quality improvement services for more than 50 years. We...

Clinical Review & Correspondence RN The Clinical Review & Correspondence RN plays a critical role in supporting utilization management operations by conducting medical necessity reviews, preparing clear and compliant clinical...

L.A. Care Health Plan is seeking a Delegation Oversight Clinical Auditor RN II in Los Angeles, California. The role involves ensuring compliance with Utilization Management regulations and performing various audits. Applicants must possess an...

Remote Rn Mds Consultant-Full Time Engage Consulting is seeking an experienced Registered Nurse (RN) with strong MDS, Case Mix, and Quality Measure experience to join our team. This is a fully remote opportunity for a detail-oriented...

Overview The Legacy/OHSU Interventional Radiology practice provides services at four locations (EMC, GSMC, MHMC and MPMC) including ambulatory clinics at each site. The IR team cares for both adult and pediatric patients with...

Prior Authorization RN - Contract Role Location Requirement: Candidate must reside in NJ, PA, NY, CT, or MD Work Model: WFH, but must be able...

Include:Serve as the primary point of contact and advocate for patient care, ensuring a seamless and proactive healthcare experience. Develop, implement, monitor, and revise individualized care plans in collaboration with the physician and other...

Job Description JOB DESCRIPTION Job Summary Provides support for care management/care coordination activities and collaborates with multidisciplinary team coordinating integrated delivery of member care across the...

Remote Care Management Nurse (Future Opportunities) Work from home within Oregon, Washington, Idaho or Utah *Please be advised that this role is part of our candidate pool, which allows us to identify and attract...

RN Utilization Mgmt Full-Time Day POSITION SUMMARY The RN Utilization Management (RN UM) functions as a support liaisons for a variety of UM functions which may include: the e-TAR process, denials management,...