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Quality Assurance (2 Openings) Responsibilities: Perform quality assurance review of peer review reports, correspondences, addendums, or supplemental reviews. Ensure clear, concise, evidence-based rationales are...

A leading health insurance provider is seeking a Utilization Management Nurse 2 to support coordinated care for members healing at home. The ideal candidate will have an Associate Degree in nursing, a valid RN license, and at least three years of...

A national risk management provider is seeking a remote Utilization Review Case Manager. This role involves gathering clinical information, certifying medical necessity, and managing stakeholder communications. Ideal candidates will have a nursing...

Medical Review Nurse The Medical Review Nurse provides support for medical claim and internal appeals review activities ensuring alignment with applicable state and federal regulatory requirements, Molina policies and procedures, and...

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...

We've made a lot of progress since opening the doors in 1942, but one thing has never changed - our commitment to serve, heal, lead, educate, and innovate. We believe that every award earned, every record broken and every patient helped is because...

A leading healthcare organization seeks an experienced individual to manage utilization review processes remotely. This role requires a Registered Nurse with leadership experience to oversee operations and collaborate with medical teams to ensure...

A healthcare provider is seeking a Case Management Coordinator for their Home Health division. This role involves functioning as a clinical liaison with managed care customers, collaborating with external case managers, monitoring service...

Medical Review Nurse The Medical Review Nurse provides support for medical claim and internal appeals review activities - ensuring alignment with applicable state and federal regulatory requirements, Molina policies and procedures, and...

Medical Solutions LTC is seeking a local contract nurse RN Long Term Acute Care for a local contract nursing job in Columbus, Ohio. Job Description & RequirementsSpecialty:...

Job Description: Sharecare is the leading digital health company that helps people - no matter where they are in their health journey - unify and manage all their health in one place. Our comprehensive and data-driven...

Join us as a Registered Nurse (RN) - Quality Coordinator RN position at Lower Keys Medical Center Unit: Quality Coordinator RN (2+ years of quality experience preferred) Shift: Remote or onsite Mon-Fri 8AM-4:00...

Anticipated End Date: 2025-12-15 Position Title: Nurse Appeals RN Job Description: Nurse Appeals RN Location: Ohio-Cincinnati, Columbus, Mason, or Seven Fields (Must be within...

Director of Nursing Inniswood Village located in Westerville, OH is an independent living, assisted living and memory care community with a team of health care professionals that is unmatched in the area! We are owned and...

Medical Review Nurse The Medical Review Nurse provides support for medical claim and internal appeals review activities, ensuring alignment with applicable state and federal regulatory requirements, Molina policies and procedures, and...

Description RN Care Managers, in the acute care setting, provide a variety of services to appropriately help progress patients through the continuum of care. Key services include screening for post-acute needs; transition...

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system...

Medical Review Nurse The Medical Review Nurse provides support for medical claim and internal appeals review activities ensuring alignment with applicable state and federal regulatory requirements, Molina policies and procedures, and...

Job Type Full-time Description Soleo Health is seeking a Nursing Operations Manager, Provider Services in Dublin, OH. Join us in Simplifying Complex care! Soleo Health...

*Employment Type:* Full time *Shift:* 12 Hour Night Shift *Description:* Qualified applicants may submit a resume to Senior Talent Acquisition Partner, Tonya Globlek at ...@mchs.com for expedited consideration. *Position Purpose: * The...

Medical Review Nurse The Medical Review Nurse provides support for medical claim and internal appeals review activities ensuring alignment with applicable state and federal regulatory requirements, Molina policies and procedures, and...

At CVS Health, were building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nations leading health solutions company, we reach millions of...

Integrated Resources, Inc., is led by a seasoned team with combined decades in the industry. We deliver strategic workforce solutions that help you manage your talent and business more efficiently and effectively. Since launching in 1996, IRI has...

We're growing - Join our award winning culture as we serve members in your area! The position will work with members in the WI Rapids, Stevens Point and Marshfield areas.

A leading healthcare provider in Michigan seeks a qualified Registered Nurse to manage and facilitate patient transfers efficiently. Candidates must have a Bachelor of Science in Nursing and at least two years of clinical experience. Strong...