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Medical Review Nurse (RN)Remote position, however candidates must reside in the State of TX or State of ILThis position is a contract for about 9 months.Pay: $41/hourRN working in the insurance or managed care industry using medically accepted...

Cincinnati Children's is seeking an experienced Utilization Review professional for a remote role in the United States. The position supports case management, authorization, compliance, and education within the Utilization Review department.

Comagine Health in Washington State is seeking an experienced registered nurse to join our remote clinical reviewer team. In this role you will assess medical necessity, appropriateness, and quality of care for Washington L&I contracts, applying...

Utilization Review Specialist (RN) – Work From Home (Florida-Based Candidates Only)Concierge Home Care | Work From Home Opportunity – Must Reside in Florida At Concierge Home Care, we are growing and looking for an experienced...

This position is offered fully Home based (Remote) As a pharmaceutical support industry leader, UBC is devoted to empowering health solutions for a better tomorrow. We take pride in improving patient outcomes and advancing healthcare. At UBC we...

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,...

Performance Home Health is seeking an experienced, detail-oriented Quality Assurance Registered Nurse to join our growing team. This is a fully remote position; however, candidates MUST reside in Texas to be considered. In this role, you...

A reputable healthcare staffing firm in Oregon is seeking a care manager specializing in phone communication with patients across all ages. The role involves coordinating care services, educating patients on their health conditions, and conducting...

WNS, part of Capgemini, seeks a remote Utilization Review Nurse to perform medical necessity reviews and collaborate with providers to ensure compliant patient care. The role emphasizes adherence to HIPAA, state and federal regulations, and a...

Valeris is hiring a Patient Support Nurse to engage program patients from enrollment through treatment, helping them initiate and complete therapy successfully. The role requires active RN licensure, 2–3 years of nursing experience, and...

Utilization Management Registered Nurse (RN) - Remote Full-time WHO IS GUIDEHEALTH? Guidehealthis a data-powered, performance-driven healthcare company dedicated to operational excellence. Our goal is to make...

Virtual Medical is seeking qualified Registered Nurses to join our fully remote 24-hour On Call Center. We handle incoming calls for clients requiring immediate medical attention and provide assessment, guidance and disposition to the appropriate...

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...

Trustaff is seeking a travel nurse RN Clinic for a travel nursing job in Los Angeles, California. Job Description & RequirementsSpecialty: ClinicDiscipline:...

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

Trillium Health Resources is seeking a Compliance Nurse to perform clinical compliance reviews and evaluate claims to ensure adherence to regulatory and coverage requirements. The role requires an Associate's degree in Nursing, NC RN licensure,...

What You'll Do As an Enrollment Nurse, your primary responsibility is enrolling patients in a chronic care management program. You'll call eligible patients, educate them about the program, answer questions, and assist interested patients...

Cohere Health is seeking a Clinical Review & Correspondence RN to support utilization management by conducting medical necessity reviews and delivering compliant clinical determinations. You will collaborate with Medical Directors and...

Hines & Associates, Inc. seeks a Registered Nurse reviewer to assess patient conditions and certify treatments according to URAC and applicable regulations. The role emphasizes clinical judgment, documentation, and collaboration with case managers...

A healthcare facility in California is seeking experienced nursing professionals to review medical records and ensure appropriate admission status. The role involves collaboration with various stakeholders, including physicians and Care...

CVS Health is seeking an experienced Registered Nurse for Medicare Precertification Utilization Management in a remote, full-time weekend schedule. The role emphasizes ensuring appropriate care, coordinating with providers, and applying guidelines...

Summit Healthcare Staffing LLC is seeking a compassionate bilingual Registered Nurse (RN) to join the Intake team for a growing home health organization in Brooklyn, NY. The role starts on-site with potential to move to a remote role based on...

Molina Healthcare seeks a Remote RN Care Review Clinician for UM/Discharge Planning in California. You will verify medical necessity, review services against guidelines, and coordinate care across the delivery continuum to achieve quality...

HealthEdge is seeking a motivated Utilization Review RN to join our team. You will perform prospective, concurrent and retrospective reviews of inpatient, outpatient, ambulatory and ancillary services to ensure medical necessity, length of stay...

Review claims files to detect potentially fraudulent billing practices.Use medical terminology and coding to assess payment appropriateness.Write investigative summary reports and provide expert testimony.Requirements:Active RN license and 2+...