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Seeking an experienced Registered Nurse Medical Reviewer, the full-time remote position will manage the medical review of complex claims, pre-authorization requests, appeals, and fraud referrals, applying clinical expertise to determine medical...

Job DescriptionMake a Difference Every Single Day at Cedars-Sinai!When the work you do every single day has a crucial impact on the lives of others, every effort, every detail, and every second matters. This shared culture of passion and...

Registered Nurse As the leader of the health care team, provides professional nursing care, utilizing the nursing process in accordance with established standards of care, policies, and procedures. Demonstrates performance consistent with...

CVS Health is seeking an experienced Registered Nurse for Medicare Precertification Utilization Management in a remote, full-time weekend schedule. The role emphasizes ensuring appropriate care, coordinating with providers, and applying guidelines...

Sentara Health is seeking a part-time Registered Nurse for a physician practice/ambulatory clinic, with remote work options. The RN will assess patients, assist with procedures, administer meds and vaccines, and coordinate care across the care...

UnitedHealth Group's UnitedHealthcare is seeking a Registered Nurse for a Weslaco, TX area role. The RN will assess, plan, and implement person-centered care, linking members with resources across financial, psychosocial, and community services,...

Humana Inc. seeks a Telephonic Care Manager, a Registered Nurse who will help ensure continuity of care for patients transitioning into and out of CenterWell Home Health services. You will determine appropriate post-acute options and...

Provides direct nursing care including: assessment, plan of care, education, and evaluation for assigned patients. Performs patient duties necessary to maintain the flow of...

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...

Performing skilled nursing facility medical claims audits, the remote Medical Review Nurse II - SNF/MDS Auditor will review claims for appropriateness, document findings, and support the appeals process while collaborating with a multi-location...

Job DescriptionMake a Difference Every Single Day at Cedars-Sinai!When the work you do every single day has a crucial impact on the lives of others, every effort, every detail, and every second matters. This shared culture of passion and...

CVS Health is seeking an experienced Utilization Management Nurse Consultant (Medicare) to review cases and guide care decisions from a remote setting. The role emphasizes collaboration with providers, evidence-based determinations, and ensuring...

Job Summary: As the leader of the health care team, provides professional nursing care, utilizing the nursing process in accordance with established standards of care, policies, and procedures. Demonstrates performance...

Sentara Health is seeking a Registered Nurse for the Physician Practice in a remote weekend day shift role (Sat, Sun, Mon 7am-7:30pm). The RN will provide care in a physician practice or ambulatory clinic, perform triage, assist with exams,...

Optum Infusion Pharmacy is seeking a Clinical Administrative Consultant RN (CAC, Clinical Coordinator) to act as a clinical liaison and coordinate home or AIS infusion therapy for patients across the U.S. The role supports initial intake,...

Humana's Utilization Management Registered Nurse uses clinical nursing skills to interpret and support coordination, documentation and communication of medical services and benefit determinations for post-acute care (SNF, Home Health, DME). You...

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Molina Healthcare is hiring a remote RN Care Manager. Preference for candidates in Washington State. This role will be working Pacific Standard Time hours. This role supports Medicare members through telephonic case management and...

Seeking a detail-oriented RN Clinical Quality Assurance Coordinator for a full-time remote position, who will manage the quality assurance review of peer review reports, ensuring compliance with client specifications and regulatory requirements...

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 deeply, innovate with purpose, hold...

Case Management Specialist RN (Bilingual)Works collaboratively with an assigned panel of physicians to manage the patients specialized needs. The managing team does differ according to the chronic disease. Duties include assessment to identify...

Vocational Nurse Opportunity Beyond outstanding employee benefits including health and dental insurance, vacation, and a 403(b), we take pride in hiring the best employees. Our accomplished staff reflects the culturally and ethnically...

Sentara Health is seeking a Registered Nurse for the Physician Practice in a remote weekend day shift role (Sat, Sun, Mon, 7am–7:30pm). The RN will provide care in a physician practice or ambulatory clinic setting, coordinate with physicians and...

UnitedHealth Group is seeking a Hospital Safe Discharge Case Manager to proactively coordinate discharge planning across acute care settings. You will work with facility CM/UM staff, medical directors, and care teams to resolve barriers and ensure...

Humana Inc is seeking a Telephonic Nurse Care Manager to support patients remotely, coordinating post-acute services and admissions. You will assess needs, educate on care options, and work with the clinical team to ensure timely and appropriate...