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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...

Clinical Review & Correspondence RN The Clinical Review & Correspondence RN plays a critical role in supporting utilization management operations by conducting medical necessity reviews, preparing clear and compliant clinical...

Ampcus Inc. is a certified global provider of a broad range of Technology and Business consulting services. We are in search of a highly motivated candidate to join our talented Team. Job Title: Clinical Medical Review Nurse.

Job Description Nemours Children's Health in JACKSONVILLE Florida at our home office location, is seeking a Virtual Care ON-SITE RN! Current opportunities: FULL-TIME,...

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

Registered Nurse (RN) - Clinical Documentation Specialist (Part Time) Remote The Clinical Documentation Specialist is responsible for the evaluation of physician documentation utilizing their clinical expertise to ensure the patients'...

...Registered Nurse, Registered, Nurse, Healthcare...

Description Location: UCHealth Anschutz Outpatient Pavilion - Aurora, CO Department: Hospital Based Sub-Specialty Work Schedule: Full Time, 80.00 hours per pay period (2 weeks) Shift: Days Pay: $38.91 - $60.31 / hour. Pay is dependent on...

" Licensed Psychiatric Nurse Practitioner Wage: Up to $196.58/hour Did you know that you can build a flexible...

Description RN Utilization Review - Remote. This position is Per Diem and will work 8-hour, Day shifts. Provide prospective, retrospective, and concurrent utilization reviews for our Southern CA...

CLINICAL REVIEW NURSE - REMOTE ARC Group has multiple positions open for Clinical Review Nurses! These positions are 100% remote. These are direct hire FTE positions with salary, benefits, etc. This is a fantastic opportunity to...

Details Client Name Adventist Health Glendale - Westways Job Type Travel Offering Nursing Profession Registered Nurse (RN)...

Requisition number: 2368763 Job category: Nursing 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...

Position SummaryDescription for Internal Candidates The Clinical Education Specialist is responsible for the planning, design and implementation of education programs/services and professional development of nurses in their...

Clinical Quality Specialist We are seeking a dedicated Clinical Quality Specialist to ensure regulatory and accreditation compliance. The ideal candidate will maintain alignment with DHCS, NCQA, and CMS requirements through ongoing...

Clinical Review Nurse - Remote ARC Group has multiple positions open for Clinical Review Nurses! These positions are 100% remote. These are direct hire FTE positions with salary, benefits, etc. This is a fantastic opportunity to join a...

Job Description Summary An Infusion Nurse II is a licensed registered nurse who coordinates and provides intermediate direct patient care to patients in the home, or in an alternate infusion suite, to ensure patient safety with continuity and...

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...

Nurse Investigator- Atlanta Conduct investigations (clinical mortality review) of deaths of individuals with developmental disability services. Interview witnesses, complainants, and persons of interest to obtain information...

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh...

LanceSoft is seeking a local contract nurse RN GI Lab for a local contract nursing job in Los Angeles, California. Job Description & Requirements Specialty: GI Lab Discipline: RN Start Date: 07/07/2026 Duration: 13 weeks 40 hours per week Shift: 10...

Job Description: Participates in the development and ongoing implementation of QM Work Plan activities. Improve quality products and services, by using measurement and analysis to process, evaluate and make...

Job Title Utilizes a collaborative review process of benefits, minimally necessary clinical information and evidence-based clinical guidelines to formulate decisions regarding medical necessity, pre-existing conditions, benefits and/or...

Registered Nurse – Clinic/Wellness/Immunization The Registered Nurse – Clinic/Wellness/Immunization works in a variety of either remote or clinic locations to serve a specific population's health and wellness needs. The Registered...

Discover Vanderbilt University Medical Center: Located in Nashville, Tennessee, and operating at a global crossroads of teaching, discovery, and patient care, VUMC is a community of individuals who come to work each day with the simple aim of...