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Cambia Health is seeking an Appeals Clinician I to evaluate and finalize clinical appeals across multiple jurisdictions. You will apply nursing judgment and medical policy to ensure compliant decisions, partnering with physicians as needed.

Ascension is seeking a Clinical Documentation Specialist to join the Clinical Integrity Documentation team in a remote, full-time capacity. The role focuses on admission reviews, DRG assignment, and ensuring documentation supports severity of...

Clinical Documentation Integrity Specialist IIThe Clinical Documentation Integrity Specialist II (CDI) is responsible for utilizing independent clinical judgement in facilitating the integrity, overall quality, accuracy, and completeness of...

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...

Memorial Hermann Health System is seeking a Clinical Documentation & Integrity Specialist for a remote role in Texas. The RN must hold a BSN or MSN and have at least five years of inpatient acute care experience, with ICU exposure preferred.

Compassus is seeking a Remote Home Health Registered Nurse - Triage to triage patient and facility calls after hours and facilitate referrals as needed. This role supports field staff, coordinates admissions, and collaborates with physicians to...

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A leading healthcare provider is seeking a Registered Nurse for their LTSS department in New York. This role involves providing case management services, evaluating medical services, and managing appeals for denied services. Candidates must...

Yoh is seeking a Utilization Management Nurse Coordinator (RN or LVN) for a 6+ month remote contract with a managed care client based in Northern California. Training occurs onsite in Fairfield or Redding for three weeks, then transitions to fully...

Who We Are: Since 1985, BHCHP's mission has been to provide or assure access to the highest quality health care for all individuals and families experiencing homelessness in greater Boston. We care for over 11,000 homeless individuals each...

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...

Centene Corporation is seeking a Licensed Practical Nurse (LPN) or Registered Nurse (RN) for a remote case management role in Pennsylvania. The selected candidate will perform concurrent reviews, determine appropriate care levels, and assist with...

UCSF Health Medical Foundation is seeking an experienced Primary Care Telephone Triage Registered Nurse to work remotely from home. The role requires a California RN license, at least two years of full-time triage or acute care RN experience, and...

WORK REMOTELY after training! CANDIDATE MUST RESIDE IN THE METROPOLITAN NEW YORK AREA! !! Process all requests for services in accordance with Medicare and NYS Medicaid guidelines as well as departmental criteria and...

Optum is seeking a remote IRR Clinical Claim Review Nurse to perform clinical review of claims against medical records and guidelines. The role requires an active RN license, 2+ years of acute care clinical experience, and 1+ year in claim review...

Allegheny Health Network is seeking an RN Clinical Document Specialist to support remote work from Pennsylvania within 50 miles of Pittsburgh or Erie. The role focuses on improving documentation accuracy to optimize reimbursement, with extensive...

Centene is seeking a remote Utilization Review Nurse to perform concurrent reviews, determine appropriate levels of care, and support discharge planning for inpatient services. You will collaborate with Medical Affairs and care teams to ensure...

AmeriPharma is seeking an Parenteral Services Clinical RN Specialist to provide expert nursing support for TPN and parenteral therapies. The role emphasizes clinical education, care coordination, and collaboration with nursing, pharmacy, and...

Corrections Registered Nurse (RN)Setting: CorrectionsJob Type: TravelPay: $2400 / WeekHours:...

A-Line Staffing Solutions is seeking a Clinical Review Nurse for a concurrent review role in a remote-capable setting. The RN will assess member eligibility through chart review and coordinate with providers to gather necessary information.

Under general supervision and according to established policies and procedures, provide remote Blood Pressure (BP) monitoring for all patients enrolled in the Blip Care program. Communicates significant blood pressure changes and patient concerns...

Centene Management Company LLC is seeking a Licensed Practical Nurse to analyze prior authorization requests and determine medical necessity in New York. You will work with healthcare providers and the authorization team to ensure timely,...

Prior Authorizations Nurse (RN) (Temporary) Remote in California OUR COMMITMENT TO A HUMAN HIRING PROCESS We believe every candidate deserves thoughtful consideration.That'swhy we do not use AI or automated...

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...

Health Care Service Corporation seeks a Quality of Care (QOC) Nurse to review and investigate potential quality of care issues in a timely manner. This role supports QA activities in line with CMS and NCQA requirements, under the supervision of...