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Job Requirements General Summary Under general supervision, conducts internal audits of hospital bills working with external auditors to ensure that uncompensated patient revenues resulting from...

WORK REMOTELY after training! CANDIDATE MUST RESIDE IN THE METROPOLITAN NEW YORK AREA! !! Process all requests for services in accordance with Medicare and NYS Medicaid guidelines as well as departmental criteria and...

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...

Float Health is seeking an Intake Specialist to manage new patient referrals and coordinate start-of-care visits. This externally facing role requires quick action, clear communication, and meticulous attention to detail to ensure timely,...

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...

Nurse Navigator Experience the HCA Healthcare difference where colleagues are trusted, valued members of our healthcare team. Grow your career with an organization committed to delivering respectful, compassionate care, and where the...

Sagility is hiring an RN Utilization Management Reviewer for a fully remote, home-based role in the United States. You will perform day-to-day clinical and service authorization reviews for medical necessity and ensure compliance with CMS...

Overview St. Francis Medical Center is one of the leading comprehensive healthcare institutions in Los Angeles. St. Francis provides vital healthcare services for the 700,000 adults and 300,000 children in our community who count on the...

Case Management Nurse The Case Management Nurse delivers comprehensive, client-centered case management services across the continuum of care, ensuring that each individual receives the most appropriate level and type of health, medical,...

Registered Nurse (RN) - IRIS Self-Directed Personal Care (SDPC) Are you seeking a unique nursing position that gives you a great work/life balance and lets you support people to live the lives that they choose? Then you'll want to keep...

Job Title: Registered Nurse (RN) Disease Manager Job Overview: The Registered Nurse (RN) Disease Manager is responsible for coordinating care and managing the health outcomes of patients with chronic or...

Cunningham Children's Home in Urbana, IL, is seeking a Nurse Case Manager to support youth with emotional, psychological, and physical care in residential programs. You will provide medical case management, screening, education, counseling, and...

WelbeHealth PACE helps seniors stay in their homes and communities by providing comprehensive medical care and community-based services. We serve the most vulnerable seniors with better quality and compassion in a value-based model.The Case...

Compliance Nurse Trillium Health Resources is a Tailored Plan and Managed Care Organization (MCO) serving 46 counties across North Carolina. We manage services for individuals with serious mental health needs, substance use disorders,...

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...

Company Overview: Join us in our mission to transform healthcare! nirvanaHealth (under RxAdvance Corp.) is committed to bringing the art of the possible to the payer and PBM industries. We invest in our employees at every stage...

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...

Benefits: 401(k) Competitive salary Dental insurance Health insurance Paid time off Signing bonus Training & development Vision insurance Outpatient Case Management West Los Angeles VAMC 11301...

Utilization Management Nurse Consultant Clinical Precertification RN (Medicare Home Care) Remote | Full-Time | Weekday Schedule We're building a world of health around every individual - shaping a more connected, convenient and compassionate...

Utilization Management Nurse Join us in our mission to transform healthcare! NirvanaHealth (under RxAdvance Corp.) is committed to bringing the art of the possible to the payer and PBM industries. We invest in our employees at every stage...

Where You'll Work With more than 700 care sites across the U.S. from clinics and hospitals to home-based care and virtual care services CommonSpirit is accessible to nearly one out of every four U.S. residents. Our world...

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...

Bon Secours Mercy Health is seeking an RN Infection Prevention professional to manage system-wide IPC activities, ensuring compliance with regulatory standards. This role supports outbreak investigation, surveillance, and performance improvement...

Umpqua Health in remote Oregon seeks a Care Coordinator to manage care for Medicaid/Medicare members. You will conduct in-home assessments, develop care plans with families and providers, and coordinate services across LTSS, behavioral health, and...

Utilization Review Nurse Auditor Fully Remote • Mount Laurel, NJ 08054 Salary Range $33.00 - $46.00 Hourly Position Type Full Time Travel Percentage 10% ExamWorks is looking for a Utilization Review Nurse Auditor to join...