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Utilization Management RN Our Utilization Management RN (Registered Nurse) evaluates efficiency, appropriateness, and medical necessity for medical services and procedures for our Health Plan. This role uses clinical knowledge to provide...

Our Utilization Management RN (Registered Nurse) evaluates efficiency, appropriateness, and medical necessity for medical services, and procedures for our Health Plan. This role uses clinical knowledge to provide judgment to...

JOB DESCRIPTION Job Summary Provides support for care management/care coordination activities and collaborates with multidisciplinary team coordinating integrated delivery of member care across the continuum. Strives to ensure member...

ScheduleMostly Monday - Friday business hours (position start date will be after July 2026)Position Statement / Position SummaryThe NPD Specialist uses tools, theories, skills and knowledge of NPD to improve the practice of staff. The NPD...

Utilization Management RN IL Regional Office - Springfield, Illinois Overview Position Type: Full-Time Job Shift: Day Education Level: Bachelor's Degree Category: Nursing Professional & Support Description...

Overview As a patient-focused organization, University of Utah Health exists to enhance the health and well-being of people through patient care, research and education. Success in this mission requires a culture of...

Utilization Review NurseWork Location: Los Angeles, CAJob #: 30315Work Hours: Monday-Friday 8am-4:30pmEmployment Type: 4 – Staff- LimitedDuration: 6 monthsSalary Range: $74.16–107.75 hourlyPosted Date: May 15, 2026Bargaining Unit: CNA –...

Care Manager The Care Manager is responsible for providing care management to a group of health plan members, creating the Person-Centered Service Plan (PCSP), coordinating services, and documenting care in accordance with health plan...

Ssbv Clinical Claims Review Rn 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 will directly improve health outcomes by connecting...

Details Client Name Kaiser Permanente Los Angeles Medical Center Job Type Permanent Offering Nursing Profession Nurse...

Join Our Caring Community As a RN Care Manager, you will enjoy a true work-life balance with no night or weekend shifts. Reporting to the Manager of Care Coaching, you will support members enrolled in the Wisconsin Family Care Program...

Payment Integrity Nurse – Medicare Advantage We are currently hiring for a Payment Integrity Nurse – Medicare Advantage to join BlueCross BlueShield of South Carolina. In this role as a Payment Integrity Nurse, you will...

The Chief Nursing Officer, CNO, has full responsibility for leading all patient care services for Pipeline Health and approved affiliates by providing the leadership, strategic guidance, and management direction necessary to fulfill the...

Become a part of our caring community Work Schedule: Full-time/40 Hours Position Type: On-site Branch Location: West Allis, WI This is NOT a remote or work-from-home position. You will sit on-site at our West Allis, WI branch location. As a...

Utilization Management Nurse RIHS Austin Regional Office - Austin, TX 78727 Overview Position Type Full Time Description Primary Responsibilities The Utilization Management Nurse will determine the...

Utilization Management Position 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...

Registered Nurse - Case Management Duration:13 Weeks Start:03/10/2025 Job Type: Travel Minimum Guaranteed Hours: 40 Jobs Notes: Day Shift, inpatient RN CM Acute hospital experience,...

The Registered Nurse (RN) is responsible for independently utilizing the nursing process to safely, therapeutically and efficiently care for a group of patients based on...

Salary Range: $88,854.00 (Min.) - $115,509.00 (Mid.) - $142,166.00 (Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los...

RN - Case Manager Case managers work to facilitate patient care by assessing patient needs, evaluating treatment options, creating treatment plans, coordinating care, and gauging progress. The overall goal for case managers is to improve...

General Information Press space or enter keys to toggle section visibility Work Location: Los Angeles, CA, USA Onsite or Remote Fixed Hybrid Work...

Job DescriptionLocated in the metropolitan area of Sacramento, the Adventist Health corporate headquarters have been based in Roseville, California, for more than 40 years. In 2019, we unveiled our WELL-certified campus – a rejuvenating place...

The position is work from home with field visits. JOB PURPOSE: This position is responsible for conducting medical management and health education programs for customers on government health care programs. Accountabilities include...

Clinical Reviewer Responsible for the review and evaluation of clinical information and documentation. Reviews documentation and interprets data obtained from clinical records or systems to apply appropriate clinical criteria and...

Registered Nurse Sanford Health, the largest rural health system in the United States, is dedicated to transforming the health care experience and providing access to world-class health care in America's heartland. The Center for...