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Cleveland Clinic is seeking an Utilization Management RN Reviewer to support remote operations from home. The role covers admission and concurrent reviews, and ensures medical necessity criteria are applied to hospital stays and discharges.

Medix is seeking a Remote Utilization Review Registered Nurse (UR RN) to bridge clinical care and hospital operations from a remote setting. Join a team optimizing patient care while safeguarding revenue integrity, with a compressed 4-day week,...

Sentara Health Plans is hiring a Clinical Claims Reviewer RN for a remote role. The position is full-time, 40 hours, with standard hours 8am–5pm EST, Monday to Friday. Remote opportunities are available across many states, including New...

St. Tammany Health System in Covington, LA is seeking a Clinical Documentation Specialist - RN to work remotely. The CDS supports accurate representation of illness severity and risk adjustment through collaboration with physicians and care teams.

Lana'i Community Health Center is seeking a Clinical Support Registered Nurse (RN) to provide administrative and clinical support to medical providers, enhancing workflow and patient care. The role primarily involves remote support with occasional...

A global talent management firm is seeking a Utilization Review Nurse for a contract role based in Pennington, NJ. The role involves performing utilization management, reviewing medical records, and coordinating discharge planning. Candidates must...

Essentia Health in Duluth, MN is hiring for a Health Services professional to conduct Managed Care Programs in coordination with third party administrators. You will help implement referral, prior authorization, and precertification processes...

Elevance Health is seeking an experienced nurse to review complex cases for medical necessity, applying clinical guidelines and nursing judgment. The role involves collaboration with physicians, case managers, and Medical Directors to optimize...

TriHealth is seeking a Clinical Documentation Specialist RN to review inpatient records, ensuring accuracy of diagnoses, severity of illness and quality measures. You will educate physicians and nurses, collaborate with coding staff, and drive...

Comagine Health in Washington State is seeking an experienced Registered Nurse to join our remote Clinical Reviewer team. The role focuses on assessing medical necessity, appropriateness, and quality of care through prospective, concurrent, and...

Amerit Consulting is seeking an experienced Utilization Management Nurse (RN) in California for a remote 6-month contract. The incumbent will support inpatient utilization review, medical necessity determinations, and facility claims compliance,...

CVS Health in the United States is seeking an experienced registered nurse to assess, plan, implement, coordinate, monitor, and evaluate options to ensure appropriate healthcare services and benefits for members. You will interact with providers,...

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...

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...

Job Title: Nurse, Clinical Medical Review Location: Columbia, MD (Primarily remote, but hybrid) Duration: 6 Months Contract PURPOSE: We are seeking a qualified RN or LPN with experience supporting HEDIS reporting and abstraction processes in a...

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...

Job Title: Clinical Quality Assurance Nurse Pay: see below Registered Nurse - $28.50/hr (Non-negotiable) LPN/LVN- $26.50/hr (non-negotiable) Regular Schedule after training: M-F...

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...

Improve the lives of others while Caring. Connecting. Growing together. Job Description - Preservice Review RN - Remote in HI (2392416) Preservice Review RN - Remote in HI - 2392416 Optum is a global organization that delivers...

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...

Ssbv Clinical Claims Review RnOptum 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 will directly improve health outcomes by connecting people with the...

As a Clinical Documentation Review Specialist (RN), you will help medical staff clarify patient records to ensure appropriate reimbursement and reflect care complexity. You will perform concurrent reviews and engage with physicians...

Comagine Health is seeking an experienced Registered Nurse for a remote Clinical Reviewer role supporting a Washington L&I contract. The position emphasizes evaluating medical necessity, quality, and appropriateness of care using established...

Health Care Service Corporation is hiring a Nurse Liaison I for Utilization Management & Quality Review. This remote nationwide role supports clinical review activities, benefit determinations and medical necessity assessments, ensuring compliant,...

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...