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A company is looking for a Clinical Auditor Registered Nurse.Key ResponsibilitiesReview medical records and documentation for compliance with healthcare standards and regulationsConduct independent medical record and compliance reviews, providing...

Job Summary: The Community Based Care Coordinator, Duals Integrated Care is responsible for managing and coordinating care for dual-eligible beneficiaries, those who qualify for both Medicare and Medicaid. This position focuses...

Providing advanced clinical appeal services, the full-time Ohio RN Clinical Case Manager will manage complex patient account denials, perform clinical reviews, and assist in the development of denial prevention strategies while working...

Providing telephonic care and support, the part-time Telephonic Nurse Practitioner - OH, MO, WI, IN Licensed will manage patient assessments, coordinate care, and ensure quality documentation while working remotely with flexible scheduling,...

A company is looking for a Perioperative Coordinator - Regional.Key ResponsibilitiesSchedule and coordinate a variety of pediatric and adult surgical and specialty/joint replacement proceduresCollaborate with Perioperative Directors and Clinic...

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...

A company is looking for a Remote Psychiatric Nurse Practitioner.Key ResponsibilitiesConduct thorough psychiatric evaluations and manage treatment plansPrescribe and monitor psychotropic medications and provide psychotherapyCoordinate care with...

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...

New York Licensed Practical Nurse Coordinator is a full-time remote position responsible for managing patient care coordination, communication with healthcare providers, and ensuring high-quality care services.Key ResponsibilitiesComplete...

A company is looking for a Utilization Review Clinician - Behavioral Health.Key ResponsibilitiesEvaluate member's treatment for mental health and substance abuse to ensure medical appropriatenessPerform prior authorization reviews and concurrent...

Working remotely in a full-time capacity, the RN Appeals and Grievances Specialist will manage the appeals process, review grievances, and ensure compliance with regulatory requirements.Key responsibilitiesManage and oversee the appeals process...

Supporting daily utilization management operations, the full-time Texas Licensed Utilization Management LPN will review authorization requests, ensure compliance with health plan requirements, and maintain documentation accuracy while working...

Providing remote patient monitoring and support, the full-time Telehealth Nurse (LPN/LVN) will conduct regular phone visits to educate members on managing chronic conditions such as hypertension and diabetes while ensuring accurate documentation...

Collaborating closely with the Chief Nursing Officer, the full-time remote Associate Chief Nursing Officer will lead nursing operations, manage a team of nurses, and assist in AI product development to ensure high-quality patient interactions and...

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...

Minnesota Licensed PMHNP, this is a remote, contract position offering flexible scheduling with minimal administrative tasks focused on tele-psychiatry.Key ResponsibilitiesProvide tele-psychiatry services to patientsManage patient intake and...

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...