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Nurse Reviewer At Commence, we're the start of a new age of data-centric transformation, elevating health outcomes and powering better, more efficient processes to program and patient health. We combine quality data-driven solutions that...

Remote - Candidate is required to reside in California. The RN School Support Manager is responsible for the clinical oversight of the designated medical care needs per the district contract. This oversight includes support of care...

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...

Registered Nurse – Utilization Review (Remote) Contract Length: 13 Weeks (Extension Possible) Facility: Providence Medical Center Location: 4101 Torrance Blvd, Torrance, CA 90503 Shift: Days – 5x8-Hour (08:00 AM – 04:30 PM)...

Appeals and Grievances Nurse Specialist RN II Job Category: Clinical Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, 90017 Position Type: Full Time Salary Range: $88,854.00 (Min.) - $115,509.00 (Mid.) - $142,166.00...

Clinical Review Nurse Duals Program Details- Brand new program of 2026 for Centene Duals = Medicare + Medicaid line of business. Members have one combined card and one authorization covering both benefit types. The duals...

Nurse Navigator Join an innovative startup health plan based in Wisconsin that is revolutionizing healthcare and empowering companies to combat the relentless rise in healthcare costs. Our mission is to provide accessible, high-quality...

Details Client Name CSMN - 1102080 - TACRI Clinical Job Type Travel Offering Nursing Profession Registered Nurse (RN)...

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When you join the growing BILH team, you're not just taking a job, you're making a difference in people's lives. **This position is remote. Candidates must be local to New England States for consideration** The Clinical...

Utilization Review Rn 1st time ok/ 2 yr exp required for utilization review rn every other weekend required or more depending on unit needs no call or floating required must have experience with milliman care guidelines and acute hospital...

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...

Prior Authorization RN - Contract Role Location Requirement: Candidate must reside in NJ, PA, NY, CT, or MD Work Model: WFH, but must be able...

Position Status: Full time Shift: 12 Hour Day Shift (United States of America) Hours per week: 36 Job Information Exemption Status: Non-Exempt A Brief Overview Member of the care delivery team will function...

Description: The Organization San Gabriel/Pomona Regional Center (SG/PRC) is a private, nonprofit agency contracted with the California Department of Developmental Services (DDS) to provide services and...

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...

Job Description The Clinical Appeals RN is responsible for the identification and resolution of technical and/or clinical based denials through appeals. The Appeals Nurse will work with Revenue Cycle staff, case management,...

We are recruiting for a mission-driven RN Educator, Clinical Documentation Integrity - Must Reside in Colorado to join our team! We're with you for life's journey. At Denver Health, purpose isn't just something we believe in-it's something...

Staff RN USC is a smoke-free environment USC is an equal opportunity, affirmative action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation,...

Medical Review RN IV – Commercial Appeals & Grievance Nurse Location: Remote – Candidate Must Reside in California Duration: 6+ Months Contract-to-Hire Schedule: Monday-Friday | 9:00 AM – 5:00 PM Pay Range:...

Are you an internal caregiver, student, or contingent worker/agency worker at UMass Memorial Health? CLICK HERE to apply through your Workday account. Exemption Status: Exempt Hiring Range:...

Vocational Nursing Opportunities Employer: Glendale Unified School District Salary: $4,437.33 - $5,558.80 Monthly Location: District-wide/Various School Sites, CA Job Type: Open Competitive Job Number: 2374...

We are so glad you are interested in joining Sutter Health! Position Overview: Aids patients in obtaining the correct level of care with the appropriate provider at the right time. Provides advance clinical telephone...

Join Us in Shaping the Future of Health Care At MVP Health Care, we're on a mission to create a healthier future for everyone. That means embracing innovation, championing equity, and continuously improving how we...

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...