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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...

Ethos Risk Services is seeking a full-time Clinical Recruiter (REMOTE) to lead hiring for the Case Management division. You will own full-cycle recruiting for nurse case managers and other clinical pros, from posting to onboarding, ensuring a...

UnitedHealth Group is seeking a SSBV Clinical Claims Review RN for a remote role nationwide. You will perform administrative reviews of inpatient hospital claims, document determinations, and ensure accurate use of screening criteria to support...

Managed Medical Review Organization is seeking a skilled registered nurse for a remote, home-office role. The position emphasizes telephonic/customer service, accurate documentation, and clinical review duties without face-to-face patient contact.

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...

Baptist Health is seeking a remote Clinical Documentation Specialist to evaluate physician documentation and ensure accurate illness severity portrayal for coding precision. The role requires an active Kentucky license and involves guiding...

GQR Healthcare is seeking a travel nurse Correctional for a travel nursing job in Downey, California. Job Description & RequirementsSpecialty:...

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...

When you join the growing BILH team, you're not just taking a job, you're making a difference in people's lives. Schedule This is a per diem, fully remote opportunity offering flexibility and work-life balance. Minimum commitment of 16 hours per...

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.

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...

Medix™ seeks an experienced Utilization Review Nurse Specialist for a fully remote role in the United States. You will evaluate medical necessity, determine level-of-care decisions, and collaborate with physicians, interdisciplinary teams, and...

Provides direct nursing care including: assessment, plan of care, education, and evaluation for assigned patients. Performs patient duties necessary to maintain the flow of...

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...

Job OverviewPay Range: $46.76hr - $51.76hrRequirement/Must Have5+ years Clinical nursing experience.2+ years Care Management.Bachelor's Degree in Nursing.In lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required...

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...

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,...

Responsibilities: How you'll change lives ...

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...

The Ohio State University is seeking a Staff Nurse (RN) for Oncology Continuing Care Triage. This remote phone triage role handles oncology patient calls, performs initial assessments, and uses triage algorithms to guide care. The nurse documents...

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...

POSITION SUMMARY Reporting to the Director, Ambulatory Services of Martin Luther King, Jr. Los Angeles (MLK-LA) Healthcare Corporation, the Ambulatory Clinical RN as the leader of the health care team, provides professional...

TRISTAR Company is seeking an experienced Utilization Review Nurse for a fully remote role across all states. The job focuses on workers' compensation utilization review—prospective, concurrent, expedited, and retrospective reviews—to...

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...

Description: FAMILY NURSE PRACTITIONER JOB SUMMARY Provides continuous and comprehensive services necessary for the promotion of optimal health, prevention and treatment, in an underserved community clinic. To perform a variety of advanced clinical...