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Optum is seeking a Utilization Review Nurse, RN, to lead inpatient utilization management, applying evidence-based guidelines and criteria to determine medical necessity for admissions and authorizations. The role requires 3+ years of...

hireops is seeking a Registered Nurse (RN) for a contract position lasting approximately 9 months. Remote work is available, but candidates must reside in Texas or Illinois. The job involves validating medical necessity, reviewing claims, and...

Job Description: The Registered Nurse (RN) is a professional caregiver who assumes responsibility and accountability for assessing, planning, implementing, and evaluating the care of patients. The staff RN utilizes the nursing process by use of...

We are so glad you are interested in joining Sutter Health! Organization: SHSO-Population Health Services-Utah Position Overview: The Virtual Mental Health Intake RN is a Registered Nurse who provides competent and...

A healthcare recruitment firm is seeking a Lead Healthcare Recruiter (Utilization Management RN) for a remote 6-month contract. The ideal candidate will have an active RN license and experience with health plan operations. Responsibilities include...

City/State Norfolk, VA Work Shift First (Days) Overview: Sentara Health Plan is currently hiring a Medical Policy Research Specialist/ Registered Nurse (RN) - Remote in Virginia! ...

An established industry player is seeking a dedicated Registered Nurse for a remote contract position focused on reviewing medical claims within the insurance sector. This role involves validating treatment plans using accepted criteria and...

We believe everyone should have confidence in navigating their healthcare. We are looking for a qualified Registered Nurse (RN) to serve our patient population in the navigation, prevention and management of their health through continuous care...

Guidehealth is seeking an Utilization Management Registered Nurse to perform medical-necessity reviews and document findings for determinations. The role involves collaborating with medical leadership, reviewing cases for appropriate treatments,...

ARC Group is seeking a Clinical Review Nurse for a 100% remote position. The role focuses on reviewing health claims, determining medical necessity, and ensuring alignment with national and local policies and standards of care. Must hold a...

Molina Healthcare is seeking a TX-licensed RN to join our Medicare team in a remote role focused on hospital discharge transition for members. The incumbent will coordinate resources, appointments and follow-up to ensure smooth transitions, with...

TurningPoint Healthcare Solutions is a rapidly growing and innovative healthcare company that supports several large national health plans to improve the quality and affordability of healthcare patients receive. We are looking for motivated...

Sentara Health Plan is hiring a Supervisor, Integrated Care Management/Registered RN for Nursing Facility/HCBS/LTSS Waiver. Remote with occasional onsite meetings in Virginia Beach or Richmond, VA. Full-time, 40 hours, 8am-5pm EST, M-F.

DaMar Staffing is seeking a Registered Nurse (RN) to review and evaluate medical necessity, appropriateness, quality, and compliance of services rendered by providers. The role covers claims analysis, provider audits, fraud detection, and...

EK Health Services is hiring a Full-Time Telephonic Nurse Case Manager (RN) for the Case Management Team. The role involves assessing, planning, coordinating and evaluating service options to help injured workers obtain timely, cost-effective care...

Cambia Health is seeking remote Care Management RNs to provide case, disease, and care coordination from home within Oregon, Washington, Idaho or Utah. This role supports a person-focused health care experience with strong clinical judgment and...

Chronic Care Manager (RN)Vitability Health of New Jersey Remote PositionOur MissionAt Vitability Health of New Jersey, we believe great care goes beyond checklists and charts—it's about relationships, trust, and walking alongside patients as...

IntellaTriage is seeking a compassionate registered nurse (RN) to join our growing team as a remote hospice triage nurse. You will provide after-hours telephone triage for hospice patients and families, assess conditions, and coordinate timely...

Nurse Reviewer I *Seeking RNs that have a current, unrestricted RN license in either the state of Illinois and/or California . Location: Virtual -...

Moments Hospice seeks a Triage RN to join the interdisciplinary team in an after-hours, fully remote role. You will assess needs, provide guidance, and coordinate care using the nursing process and Telecare protocols. Ideal candidates are...

Job Description This posting is for multiple openings of a Call Center Advice RN at The Nurse Advice Call Center in Brea, CA! We offer Part Time and Full Time positions, based on availability. Please ask at the time...

UnitedHealth Group is seeking a Registered Nurse Clinical Annotator to support AI-driven prior authorization in healthcare. You will interpret clinical data, apply guideline-based criteria, and ensure accurate annotations for model training. This...

UVA Health is seeking a Registered Nurse (RN) in Utilization Management for a remote role. You will leverage acute care experience to navigate complex clinical scenarios, determine medical necessity, and collaborate with interdisciplinary teams.

Utilization Management - Clinical Nurse - Work from Home! Utilization Management - Clinical Nurse - Work from Home! Get AI-powered advice on this job and more exclusive features.Direct message the job poster from BroadPathGlobal Talent Attraction...

Florida Telehealth Medical Group is seeking a Remote Registered Nurse to work 100% online, reviewing patient histories and guiding care via telehealth platforms. You will participate in online visits, educate patients, and adhere to established...