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NTT DATA is seeking a Clinical Reviewer Specialist to perform clinical and medical necessity reviews for appeals, ensuring compliance with state and federal regulations, Medicaid, and NCQA standards. This fully remoteFlorida-based position...

CVS Health is seeking a Utilization Management Nurse Consultant (Medical Review) to ensure members receive timely, medically necessary care through thoughtful clinical review and collaboration with providers. This fully remote role leverages your...

Intermountain Health is seeking an RN Utilization Review Care Management I for remote work. The role focuses on screenings, assessments, and evaluations to ensure cost-effective, high-quality care while coordinating with patients, families,...

BlueCross and BlueShield of South Carolina seeks an RN Medical Reviewer II to join the Palmetto GBA Medical Review team. You will perform medical reviews using clinical information, apply guidelines, and help ensure accurate coverage and payment...

Vail Health has become the world's most advanced mountain healthcare system. Vail Health consists of an updated 520,000-square-foot, 56-bed hospital. This state-of-the-art facility provides exceptional care to all of our patients, with the most...

HCSC is seeking a remote QOC Nurse under the supervision of the QOC Manager to conduct review and investigation of quality of care issues. The role supports quality improvement activities in compliance with CMS, NCQA and other regulatory...

Sentara Health is hiring an Integrated Case Manager, RN. This remote role requires travel to Roanoke, VA for in-person assessments and periodic member visits. You will manage care plans, coordinate services, and collaborate with medical directors...

Peraton, through SafeGuard Services (SGS), is seeking a Nurse Reviewer to conduct medical record reviews and determine claim payments with sound clinical judgment. The role involves researching Medicare regulations, identifying billing issues, and...

HCS 247 is seeking a travel nurse RN Case Manager, Acute Care Case Management for a travel nursing job in Los Angeles, California. Job Description & RequirementsSpecialty:...

The Clinical Research Nurse (CRN) will provide direct patient care to patients enrolled in or considering a clinical trial. The CRN, in collaboration with the satellite physician(s), is responsible for the implementation and evaluation of clinical...

TriWest Healthcare Alliance is seeking a Utilization Management Clinical Review nurse to assess medical necessity and manage prior authorizations for Behavioral Health and Medical/Surgical requests. You will apply InterQual criteria, document in...

Job PostingWork Location: Los Angeles, CA, USAWork Schedule Monday-Friday 8am-5pmSalary Range: $70.59 - 106.80 HourlyEmployment Type 2 - Staff: Career Duration IndefiniteThe position requires flexibility to travel and float to other clinic...

City/State Virginia Beach, VA Work Shift Second (Evenings) Overview: Sentara Medical Group is now hiring a part-time Registered Nurse - Physician Practice. Clinic...

IntellaTriage is seeking a compassionate registered nurse (RN) to join our after-hours team to triage hospice patients and families by phone with empathy and professionalism. As a remote RN, you will coordinate care, document interventions,...

Vivo Care, a patient-centered health platform, seeks a Care Navigator (RN/LPN/LVN) for remote work in the CST window. You'll build trusted relationships with patients, conduct wellness calls, and coordinate care using RPM data to drive health...

AmeriPharma is seeking a Clinical Intake Registered Nurse (RN) to provide nursing-focused clinical review and coordination for patients referred to specialty pharmacy, home infusion, and ambulatory infusion services. This fully remote role...

Trinity Health At Home is seeking a Virtual Care Coordinator RN to deliver telehealth hospice care and coordinate individualized care plans for patients and families from a remote setting. The role involves monitoring patient conditions,...

Schedule Available: 9:00 AM to 5:00 PM, Monday - Friday * With additional hours during evenings, weekends, and on-call; as needed. Benefits Include: Low patient-to-nurse...

HonorVet Technologies is seeking a travel nurse RN Research / Clinical Research for a travel nursing job in Santa Monica, California. Job Description & RequirementsSpecialty:...

Job Description RN - Ambulatory Surgery PreOp/PACU at Providence Saint John's Health Center in Santa Monica, CA. This position is Per-Diem and will work 8-hour, Day shifts. Join Providence Saint John's Health Center,...

The University of Texas MD Anderson Cancer Center is seeking a Denials Management Coordinator to support revenue cycle operations by coordinating review, analysis, and resolution of insurance denials and to help secure accurate reimbursement. This...

Sedgwick is seeking an RN Telephonic Case Manager to support injured workers remotely. You will partner with workers, employers, and medical providers to develop care plans that promote medical recovery and a successful return to work. The...

JOB DESCRIPTIONWe are searching for six TX licensed RNs to work telephonically with our Medicaid members across the state. Three of the positions are open to RNs with at least two years of experience in in Behavioral Health or Substance Abuse...

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...

Description Research Nurse (Per Diem) - Oahu, Hawaii Illingworth Research Group provides a range of patient focused clinical services to the pharmaceutical, healthcare, biotechnology and medical device industries. These include...