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Job Summary: As the leader of the health care team, provides professional nursing care, utilizing the nursing process in accordance with established standards of care, policies, and procedures. Demonstrates performance consistent...

Elevance Health is seeking a Clinical Review Nurse I to review and determine whether a claim meets the benefits the member carries. This virtual, full-time role offers flexibility with in-person training sessions and potential alternate locations...

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...

Program Integrity Clinical Compliance AuditorOptum Insight is improving the flow of health data and information to create a more connected system. We remove friction and drive alignment between care providers and payers, and ultimately consumers.

Sentara Health is seeking a part-time Registered Nurse for a physician practice setting in a remote capacity. The RN will assess patients, assist with procedures, administer medications, and coordinate with physicians and staff to ensure...

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

ExamWorks is seeking a self-driven RN or LPN to join as Clinical Quality Assurance Coordinator. This 100% remote role focuses on QA of peer review reports, ensuring accuracy, clinical citations, and adherence to client specifications and...

VHC Health in Arlington, VA is seeking a Virtual Nurse/Nursing Care Partner to provide indirect nursing care to assigned patients across inpatient units via remote technology. The role supports admissions, education and discharge planning with...

Providence Tarzana Medical Center in Tarzana, CA is seeking a Certified Nursing Assistant for the Cardiovascular Unit. This Full-Time role requires CA Nursing Assistant Certification, BLS, and completion of the Nursing Assistant course, with...

8 Hours POSITION SUMMARY The Clinical Staff Nurse is a skilled and experienced professional Registered Nurse (RN) responsible for excellence in the clinical practice of nursing and the management of patient care.

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.

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.

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...

HonorHealth is seeking an Utilization Review RN Specialist to review and monitor the utilization of health care services, ensuring medical necessity and appropriate levels of care. You will coordinate reviews for Medicare, AHCCCS, self-pay, and...

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.

Prime Staffing is seeking a travel nurse RN Research / Clinical Research for a travel nursing job in Fullerton, California. Job Description & RequirementsSpecialty:...

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...

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...

Essential Duties and Responsibilities: Review requests for services including admission, discharges and continued stays for adherence to clinical criteria, state and federal policy, and related requirements. Issue...

Seeking an experienced Registered Nurse Medical Reviewer, the full-time remote position will manage the medical review of complex claims, pre-authorization requests, appeals, and fraud referrals, applying clinical expertise to determine medical...

NaphCare is hiring a Registered Nurse for the Family and Friends Line (FFL) as part of our Local Government team for our Corporate Office in Birmingham, AL. This position is remote and bilingual capability is required to assist families of...

Freeman Health System is hiring for a remote/hybrid position in Utilization Review and Case Management. The role focuses on assisting Emergency Department patients with their social and discharge needs. Candidates must be licensed RNs with strong...

Ensemble Health Partners is seeking an experienced RN for Utilization Review to assess medical necessity and optimize hospital and patient care. This remote role involves coordinating with the FCC, care management, and interdisciplinary teams to...

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...

Responsibilities Plans, implements, coordinates, and evaluates comprehensive care for designated patients to ensure quality of care and continuity of care delivery through telehealth platforms. QualificationsMinimum...