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Humana is seeking a Utilization Management Nurse to support coordination, documentation, and communication of medical services and benefit determinations. This role suits experienced nurses who can work independently and make critical patient-care...

Emanate Health in Covina, CA, seeks a Utilization Review Nurse to evaluate medical records and determine medical necessity using policies and guidelines for urgent and standard reviews. You will document decisions and support claims reviews,...

University Hospitals is seeking a Registered Nurse to collaborate with the health care team to coordinate admissions, continued stays, and level-of-care decisions. You will communicate with patients and families to ensure timely care and proper...

Lead complex care management for members with primarily physical health needs through comprehensive assessments, person-centered care planning, coordination, education, and ongoing monitoring. Support PHCO Case Management and collaborate with...

Provide essential clinical and administrative support to a remote healthcare team across Canada. Manage laboratory results, pharmacy communications, referrals, and patient follow-ups. Requirements: Current...

Provides direct nursing care including assessment, plan of care, education, and evaluation for assigned patients. Performs patient duties necessary to maintain the flow of...

Job Title : Registered Nurse (Navy Nurse Corps) Category / Component : Officer • Both Overview Navy Nurse Corps officers deliver professional nursing care to service members, families, and global communities in leading edge military medical...

Lee Health is hiring for a Utilization Management RN position. This remote role begins onsite for the first 90 days and requires licensure in Florida. The nurse will perform utilization management duties, ensure regulatory compliance, and document...

**JOB SUMMARY** This job works with appropriate departments in the areas of compliance, process improvement, medical record review and coding, and member and provider satisfaction for all product lines. Recommends and implements process...

100% REMOTE PAY: $47-$52/hr REQUIRED: Must have current RN licensing Post market medical device experience in either medical assessment, complaint handling, post market reporting – preference is actual medical device assessment Highly prefer...

A healthcare services provider is seeking a Remote Utilization Review Nurse to coordinate clinical resources, ensuring compliance with healthcare standards. Responsibilities include processing authorizations, reviewing documentation, and...

Opco-Skilled-Management- is seeking a Central Intake Nurse to coordinate initial and ongoing referral documentation from physicians, insurers, and providers to determine service appropriateness and facility placement. You will develop patient care...

At UK King's Daughters, we're not just a healthcare facility - we're a family of dedicated professionals who share a passion for making a meaningful difference in the lives of our patients. We're more than just a place to work; we're a place to...

Horizon Blue Cross Blue Shield of New Jersey empowers our members to achieve their best health. For over 90 years, we have been New Jersey's health solutions leader driving innovations that improve health care quality, affordability,...

Job Title: Nurse, Clinical Medical Review Location: Columbia, MD (Primarily remote, but hybrid) Duration: 6 Months Contract PURPOSE: We are seeking a qualified RN or LPN with experience supporting HEDIS reporting and abstraction processes in a...

Optum is seeking a Fertility Utilization Management RN to work remotely within the United States. You will assess and determine the appropriateness of inpatient and outpatient services, translating clinical concepts into practical care-management...

Registered Nurse (RN) For Utilization Management Team We are seeking a Registered Nurse (RN) to join our Utilization Management team. In this role, you will perform concurrent reviews, prior authorizations, medical necessity reviews,...

Supports the values of service excellence, teamwork, and integrity while managing patient care.Acts as a liaison among patients, caregivers, multidisciplinary teams, and payers.Qualifications:Requires a current RN license, nursing diploma or...

Details Client Name Dignity Health California Hospital Medical Center Job Type Travel Offering Nursing Profession Nursing...

Field Nurse Case Manager - Glendale, CA Introduction At Gallagher Bassett, we're there when it matters most because helping people through challenging moments is more than just our job, it's our purpose. Every...

Overview Our client is a trusted leader in healthcare services, dedicated to improving outcomes for patients and providers through innovative solutions and high-quality care. Join a team committed to making a meaningful difference in the...

Private Health Management is seeking a Nurse Advisor to guide clients through complex healthcare journeys, educating and advocating for high‑quality care. You'll coordinate care, support families, and collaborate with clinical and operations...

Aurora Health Care in Milwaukee, WI seeks an experienced Registered Nurse for a Transitional Care Manager role, focused on high-risk patients during discharge and the 30-day post-discharge period. You will assess needs, develop care plans,...

Clinical Documentation Improvement Specialist-RN- Remote The Clinical Documentation Improvement (CDI) Specialist Registered Nurse (RN) assists with the identification of diagnoses, conditions, and procedures that are representative of the...

Remote Registered Nurse – Clinical Review Fully Remote | $48–$65/hr | Monday–Friday, 9:00 AM–6:00 PM ET Medix is supporting a healthcare technology organization that is adding experienced RNs to its clinical...