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nTech Workforce seeks a HEDIS Clinical Review Nurse to support an annual HEDIS retrospective project. You will drive medical record retrieval, abstraction, provider outreach, and quality measure management in a team focused on compliance and...

CVS Health is seeking an experienced Registered Nurse for Utilization Management. This 24/7 role requires clinical expertise to assess and coordinate care, determine coverage and promote optimal health outcomes. You will engage with...

Elevance Health is seeking a Nurse Case Manager I to perform telephonic and on-site care management for members with complex needs. The role supports discharge planning and requires licensure and clinical experience. This position...

Optum is seeking an experienced Behavioral Health Integration Nurse Case Manager to serve as a clinical liaison between OptumCare/Care Delivery and the clinical network. This role coordinates assessments, plans, and services to meet members'...

Centurion Health is seeking a Full-Time CQI Specialist for our Regional Office team. This remote/traveling position requires residing in Northern Illinois with a commutable distance for site visits (2-4 days/week) and occasional travel to...

CareHarmony is hiring a Licensed Practical Nurse (LPN) in Oklahoma City to join their team in delivering value-based care management. The role involves conducting health assessments, coordinating resources for chronic care, and educating patients.

Full-time Company Description WHO IS GUIDEHEALTH? Guidehealthis a data-powered, performance-driven healthcare company dedicated to operational excellence. Our goal is to make great healthcare affordable,...

CSI Pharmacy is seeking a Regulatory and Compliance Nurse to lead employee health programs across states, ensuring TB screening, immunization tracking, and regulatory adherence under OSHA/CDC guidelines. The role involves collaboration with...

CorVel Corporation is seeking a caring, self-motivated Registered Nurse to fill a Medical Case Manager role covering Newnan, Columbus, LaGrange, Fayetteville, Stockbridge, Metro ATL and surrounding areas in Georgia. The position blends...

To support timely and compliant care decisions, the full-time Utilization Management Nurse RN will review medical necessity requests, apply evidence-based criteria, and document determinations while working Monday to Friday, 8:00 AM-5:00 PM...

Public Consulting Group is seeking a Client Success Partner for EDPlan Health. You will manage relationships across states, deliver training, and lead client engagements focusing on school nurse EHR workflows. The role blends nursing...

Case Management Utilization RNPrimary Location: Panorama City, California Facility Name: Panorama City Medical Offices 4 Employee Status: Regular Schedule: Part-time Scheduled Weekly Hours: 32 Shift: Day Salary: $68.95 - $84.38 / hour Job Number:...

About the opportunity: Vail Health has become the world's most advanced mountain healthcare system. Vail Health consists of an updated 520,000-square-foot, 56-bed hospital. This state-of-the-art facility provides exceptional care to all of...

Quality Assurance Specialist (QA RN)Pay Range: $40 - $50 per hourJob Type: Part TimeLocation: RemoteJob Summary Buena Vista Home Health is seeking an experienced OASIS Review Nurse (Registered Nurse – RN) to support clinical quality, regulatory...

Care Manager Care Manager will manage Community Health Choice (Community) members with chronic disease and medically complicated needs through comprehensive evaluation and through coordination of Community resources. The Care Manager will...

Job Summary and ResponsibilitiesAs our Educator in Critical Care Emergency, In accordance with our mission and core values of integrity, compassion, collaboration, and excellence, this position is established to serve as a consultant/resource...

Humana, Inc. is seeking a Behavioral Health Nurse for Utilization Management, coordinating medical services and benefit determinations in a remote-capable role based in Indiana. You will interpret criteria and policies to support member...

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Job Details Job Location: COLUMBUS, OH 43213 Position Type: Full Time Salary Range: $57,648.00 - $81,051.00 Salary Summary: The RN Care Coordinator - Remote Patient Monitoring (RPM) functions as a registered nurse...

WPS Health Solutions is seeking a Case Management RN to coordinate care for members with complex health needs. You will develop and monitor member-centric plans, educate members and families, and liaise with providers to ensure high-quality,...

UnitedHealth Group's Optum Care at Home team is seeking a Telephonic RN Case Manager in Washington. You will conduct telephonic assessments, develop person-centered care plans, and coordinate transitions across Medicare and Medicaid services while...

Thank you for considering a career at Ensemble! Ensemble is a leading provider of technology-enabled revenue cycle management solutions for health systems, including hospitals and affiliated physician groups. They offer end-to-end...

CVS Health is seeking a Utilization Management Nurse Consultant to operate in a remote capacity from New York. This role supports a 24/7 utilization management team with weekend, holiday, and evening shifts, coordinating care decisions and...

Saint Alphonsus Health System is seeking a Peer Review Coordinator to manage data collection, analysis, and reporting for performance improvement and physician peer reviews. You will coordinate with Medical Staff Office and Risk Management while...

The VITAS Telecare RN is a member of the interdisciplinary team who is the pivotal person responsible for identifying the physical, psychological, social, and spiritual needs of those patients and families needing assistance after normal business...