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Exceptional care starts with exceptional people. For us, this is more than a job– it's a calling. It's waking up each day, looking for ways to make a difference with a compassionate, inclusive and talented team. Ochsner empowers you...

About the job Mercor connects elite creative and technical talent with leading AI research labs. Headquartered in San Francisco, our investors include Benchmark , General Catalyst , Peter Thiel , Adam D'Angelo , Larry Summers , and Jack...

Alignment Health is seeking an inpatient review nurse to join our remote utilization management team. The nurse will collaborate with the patient's PCP, facility case manager, discharge planner, and contracted providers to ensure appropriate,...

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 consistent...

Our client, a mutual benefit corporation and health plan provider, seeks an accomplished Registered Nurse (Utilization Management). *** Candidate must be authorized to work in USA without requiring sponsorship...

Essential Duties and Responsibilities: Review requests for services including admission, discharges and continued stays for adherence to clinical criteria, state and federal policy, and related requirements. Issue...

Redesigning heart health via virtual cardiac rehab for older adults.Mission-driven team of clinicians and engineers.Responsibilities:Review EMRs to determine eligibility and create orders.Conduct video intake assessments and treatment...

Allina Health is seeking a Nurse Informaticist to join the Information Systems Optimization Solutions team. The role focuses on integrating nursing practice with data science to improve patient outcomes and care quality across inpatient and...

Concierge Home Care | Remote Opportunity | Growth Opportunities | Increased Earning Potential At Concierge Home Care, we are growing and looking for an experienced Utilization Review Specialist (RN) to join our remote home health...

OU Health seeks an experienced Utilization Review Nurse (RN) to support the Children's Behavioral Health Center. The role involves evaluating medical necessity, coordinating with Payors, and ensuring appropriate hospital stay authorizations after...

OpTech is seeking a Registered Nurse (RN) to support utilization review and clinical review activities for a Michigan health plan. This role involves evaluating medical services for medical necessity, level of care, and clinical criteria. The...

A healthcare services provider is seeking a Remote Utilization Review Nurse to coordinate clinical resources, ensuring compliance with healthcare standards. Responsibilities include processing authorizations, reviewing documentation, and...

HealthEdge Software, Inc. is seeking a highly motivated Utilization Review RN to join our team. The RN will perform prospective, concurrent and retrospective reviews of inpatient, outpatient, and ancillary services to ensure medical...

Iconma Portal is seeking a Registered Nurse-Review Analyst for a remote position with a Health Insurance client. You will conduct prospective, concurrent, and retrospective reviews across inpatient, outpatient, ambulatory, and ancillary services...

Sentara Health Plans seeks an RN Clinician to perform utilization management and claim reviews across inpatient and outpatient settings. The role supports pre/post payment reviews and authorization assessments, ensuring compliance with policy and...

Registered Nurse - Case Management - Travel | Torrance, California Estimated Weekly Pay: $1935.10 Start Date: 11/09/2026 | Duration: 13 Weeks Shift: 5 x...

Managed Medical Review Organization is seeking a skilled registered nurse for a remote, home-office role. The position emphasizes telephonic/customer service, accurate documentation, and clinical review duties without face-to-face patient contact.

Review NurseThis is a contract assignment that will start right away and end on April 30th 2024Summary Description:The review nurse is responsible for medical record abstractions and overreads during the annual Healthcare Effectiveness Data and...

Machinify is seeking a Medical Review Nurse to perform CMS/RAC audits for government payers. This remote role involves working with a multi-location team to review claims, document findings, and support appeals. RAC certification is preferred and...

Alignment Health is seeking an inpatient review nurse to join the remote utilization management team. The role focuses on reviewing inpatients with complex medical needs, coordinating with PCPs, facilities, and community resources to ensure...

Clinical Documentation Quality Improvement (CDQI) Specialist, you will play a pivotal role in elevating the impact of our medical record documentation. You will conduct daily evaluations and engage in direct communication with providers to enhance...

Job Profile Summary Position Purpose: Analyzes all prior authorization requests to determine medical necessity of service and appropriate level of care in accordance with national standards, contractual requirements, and a member's...

American Health Plans Franklin, TN 37067, USA Description American Health Plans, a division of Franklin, Tennessee-based American Health Partners Inc. owns and operates Institutional Special Needs Plans (I-SNPs) for...

Molina Healthcare is seeking a Care Review Clinician (RN or LPN) for a remote, full-time position operating 8a-5p Pacific Time, Monday through Friday. You will support clinical member services review processes, verify medical necessity, and ensure...

HealthEdge in the United States seeks a Telephonic Utilization Management RN for Behavioral Health to coordinate care and perform medical necessity reviews across inpatient, outpatient, and ancillary services. Coordinate care through the health...