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Evaluating medical necessity and appropriateness for claims, the full-time State Licensed Legal Nurse will review liability demand packages, analyze medical records, and support negotiation and litigation efforts in a remote environment.Key...

Supporting high- and rising-risk patients, the part-time Nightingale RN Care Coordinator will leverage clinical expertise for comprehensive care coordination and chronic disease management while working remotely between 8:00 AM and 4:30 PM.Key...

Evaluating and managing catastrophic episodes of illness, the full-time remote South Carolina Licensed Stop Loss RN will facilitate cost estimates for underwriting, consult on claims, and provide case management oversight.Key...

Evaluating and managing catastrophic episodes of illness, the full-time South Carolina Licensed Stop Loss Nurse will provide case management oversight, facilitate cost estimates for underwriting, and consult on claims, all while working...

Seeking a remote California RN/LVN Utilization Management professional, the full-time nurse will review prior authorization requests for medical necessity across inpatient and outpatient services, applying CMS guidelines and Milliman Care...

Certified Charge Capture Analyst, a full-time remote position, is responsible for advising on charge codes, monitoring charge capture and revenue trends, and ensuring compliance with billing guidelines to enhance revenue generation.Key...

Referral Authorization Specialist is a full-time position responsible for processing and documenting referral or prior authorization requests, providing customer support for clinical areas and patients.Key ResponsibilitiesOversee data entry and...

Providing advanced clinical appeal services, the full-time Remote Clinical Financial Case Manager RN will manage complex patient account denials, conduct clinical reviews, and assist in developing denial prevention strategies while supporting the...

Leading a dedicated team in a full-time remote capacity, the Registered Nurse Manager, UM Operations will manage compliance and regulatory functions, oversee prior authorization processes, and implement strategies for the Utilization Management...

To support the education of future healthcare leaders, the part-time Arizona Licensed Nurse Educator will teach Advanced Pathophysiology and Pharmacology online, delivering high-quality instruction while maintaining compliance with accreditation...

To support patient care initiatives, the full-time Bilingual LPN Care Coordinator will manage outbound phone calls to patients, addressing healthcare needs and facilitating access to resources in a fully remote environment.Key...