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Working remotely, the full-time RN Utilization Management will review and document member case histories and prior authorization requests, utilizing clinical judgment to determine coverage eligibility while ensuring compliance with policies and...

Nurse Navigator Join an innovative startup health plan based in Wisconsin that is revolutionizing healthcare and empowering companies to combat the relentless rise in healthcare costs. Our mission is to provide accessible, high-quality...

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...

RN / Medical Reviewer / Remote Job Details Professional Discipline : Registered Nurse Specialty : Utilization Review Employment Type : Full Time City :...

Health Advocates Network is currently seeking a Licensed Vocational Nurse to work at a facility in Downey, California. These are registry positions with our company. Pay Rate: $30 /...

Case Manager RN- Weekends Sign On Bonus Potential: 5,000 Randallstown, MD NORTHWEST HOSPITAL NW CARE MANAGEMENT Part-time - Weekends - Day and Evening shifts - 8:30am-7:00pm RN OTHER 95141 $40.12-$62.19 Experience based Posted: June 24, 2026 Apply...

The organization is nationally recognized for excellence in patient care and patient experience, and the College of Healthcare Information Management Executives (CHIME) has identified PIH Health as one of the nations top hospital systems for best...

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...

Harris Health is seeking a Utilization Management Review Nurse (UMRN) in Houston, Texas, to evaluate the necessity and efficiency of medical services. The ideal candidate will hold a Bachelor's in Nursing and a valid Texas RN license, with 5 years...

Maximus is hiring a Clinical Reviewer RN/LPN to support our LTSS Tennessee contract. Areas will include but are not limited to PASRR Level 1 and Katie Beckett. In this role, you will review clinical documentation and requests submitted by...

The Utilization Management Nurse Reviewer plays a crucial role in healthcare systems by ensuring that medical services are used efficiently and appropriately. They review medical records, treatment plans, and patient information to determine the...

Description: About Us Hines is a nationwide, independent leader in personalized managed health care, focused on what's important to you—comprehensive services with the program excellence and cost containment that you demand. Hines & Associates,...

Position Title: Telephonic Triage Nurse Case Manager (Remote) 2026-1475 Location: Dallas, TX, USA Job Category: Medical Case Management Job Type: Full-Time Description:...

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...

CAREER OPPORTUNITY OFFERING: Bonus Incentives Paid Certifications Tuition Reimbursement Comprehensive Benefits Career Advancement The base pay for this position is $80,000 Must be able to work Full-time on-site at DKH - Day Kimball Healthcare in...

Nurse Care Manager (Registered Nurse) The duties of the Nurse Care Manager (Registered Nurse) are but is not limited to the following: Assesses, plans, implements, and evaluates care-based age specific components.

Train patients and caregivers on PD procedures and self-care. Manage a caseload of PD patients, including assessments and care planning. Monitor treatment progress, conduct home visits, and provide on-call support. Collaborate with interdisciplinary...

Find your calling at Mercy! Provides on call registered nursing support outside of regular business hours to meet patient care and operational needs across assigned departments or service lines. Utilizes clinical nursing knowledge and judgment to...

Overview: RN / Registered Nurse, Home Health ...

Overview Carenet Health is not authorized to hire in certain states due to internal business considerations: CA, CO, NY, NJ, NV, OR, WA, MD, RI, WV, AK, HI, CT, DE, VT, or Puerto RicoAre you a compassionate, self-motivated registered nurse with...

Clinical Quality Assurance Nurse (RN or LPN)Schedule: 3 different openingsM-F 11:30am – 8pm ESTM-F 8am-5pm ESTTues – Sat 8am-5pmPay:$24/hr for Licensed Practical Nurse (non- negotiable)$29/hr for Registered Nurse (non-negotiable)Training &...

*Description* RN - Medical Surgical at Providence Little Company of Mary Torrance in Torrance, CA. This position is Full Time and will work 12-hour, Day shifts. ...

Requisition number: 2368734 Job category: Nursing Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team...

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...

The Clinical Documentation Specialist is responsible for the evaluation of physician documentation utilizing their clinical expertise to ensure the patients' severity of illness is accurately portrayed in the medical record for specificity of...