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Opus Medical is seeking a Nurse Liaison to coordinate care and communicate crucial medical information in the United States, specifically in Pensacola, Florida. This remote role involves responsibilities like managing case plans, building...

To support Oregon Medicaid, the full-time Oregon Licensed Utilization Review Clinician will conduct clinical reviews and assessments related to mental health and substance abuse services, ensuring medical appropriateness for both inpatient and...

CVS Health is hiring a full-time RN for healthcare services and utilization management. The role emphasizes assessing and coordinating care, applying clinical criteria, and communicating with providers to optimize member outcomes. The...

Centene Corporation seeks an experienced RN to analyze prior authorization requests from a remote location within the United States. The role evaluates medical necessity and appropriate level of care in line with national standards and contract...

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...

Centene Management Company LLC is seeking a Licensed Practical Nurse to analyze prior authorization requests and determine medical necessity in New York. You will work with healthcare providers and the authorization team to ensure timely,...

Molina Healthcare is hiring a remote RN Care Manager. Preference for candidates in Washington State. This role will be working Pacific Standard Time hours. This role supports Medicare members through telephonic case management and...

Sentara Health Plans seeks an RN Clinician to perform utilization management and claim reviews across inpatient and outpatient settings. The role supports pre/post payment reviews and authorization assessments, ensuring compliance with policy and...

Float Health is hiring a Recurring Care Specialist for a fully remote US-based role. You will coordinate nursing visits, interface with pharmacies, nurses, and patients, and manage scheduling and communications across platforms. The role...

Yoh is seeking a Utilization Management Nurse Coordinator (RN or LVN) for a 6+ month remote contract with a managed care client based in Northern California. Training occurs onsite in Fairfield or Redding for three weeks, then transitions to fully...

HonorHealth is seeking an experienced Utilization Review RN Specialist for a remote-capable role serving the greater Phoenix area. The position focuses on reviewing medical necessity and coordinating reviews for diverse payers, ensuring...

Freeman Health System is hiring for a remote/hybrid position in Utilization Review and Case Management. The role focuses on assisting Emergency Department patients with their social and discharge needs. Candidates must be licensed RNs with strong...

Nurse Case ManagerPosition Type: Full-Time Contract RoleLocation: Work from homeWork Type: Remote Est. Pay Range: $35.00/hour – $38.46/Hour on W2 (USD) (all inclusive)Schedule: Mon-Fri 8am-5pm ESTRegistered Nurse with active state license in...

Clinical Review Nurse - Prior Authorization Various, NV Clinical Review Nurse - Prior Authorization Various, NV All On-site Location: Fully Remote – Prefer Candidates reside in NV, but can reside elsewhere if they...

CVS Health is seeking a Nurse Consultant for Utilization Management in a 100% remote role. You will apply clinical judgment and evidence-based criteria to review inpatient and outpatient services, collaborate with providers to authorize care, and...

Sentara Health Plans is hiring a Clinical Claims Reviewer RN for a remote role. The position is full-time, 40 hours, with standard hours 8am–5pm EST, Monday to Friday. Remote opportunities are available across many states, including New...

TalentBurst, Inc is seeking a travel nurse RN Research / Clinical Research for a travel nursing job in Fullerton, California. Job Description & RequirementsSpecialty:...

Improve the lives of others while Caring. Connecting. Growing together. Job Description - Preservice Review RN - Remote in HI (2392416) Preservice Review RN - Remote in HI - 2392416 Optum is a global organization that delivers...

Southcoast Health seeks a Team Lead-Centralized Clinic Support to join a remote role serving MA/RI communities. The role guides nursing staff, ensures clinical workflow compliance, and drives care coordination and patient safety across ambulatory...

Care Access is seeking a Registered Nurse, Clinical Delivery (RN) to remotely manage communication of critical and abnormal lab results to patients across the United States. You will educate patients, document interactions, and escalate to...

Essentia Health in Duluth, MN is hiring for a Health Services professional to conduct Managed Care Programs in coordination with third party administrators. You will help implement referral, prior authorization, and precertification processes...

JOB DESCRIPTION Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and...

Ensemble Health Partners seeks a Manager for Utilization Review to lead the centralized Virtual Utilization Management program, coordinating clinical and operational excellence in authorizations, denials, and appeals for inpatient, observation,...

argenx SE is seeking a Nurse Case Manager to serve as the primary contact for patients and caregivers across the Western time zone. You will educate patients with gMG, review insurance coverage, and coordinate therapies to support adherence and...

CVS Health is hiring a Nurse Consultant for a 100% remote Utilization Management role. You will apply clinical judgment to review inpatient and outpatient services, authorize care, and collaborate with providers while maintaining precise...