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Redesigning heart health via virtual cardiac rehab for older adults.Mission-driven team of clinicians and engineers.Responsibilities:Review EMRs to determine eligibility and create orders.Conduct video intake assessments and treatment...

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...

CVS Health is recruiting for an RN Concurrent Review Nurse in a remote capacity, focusing on inpatient clinical expertise to ensure medically necessary care across the continuum. The role requires an active RN license and 5+ years of...

HBiz seeks a Clinical Appeals Nurse (RN) to remotely support revenue cycle operations. You will review denied claims for clinical accuracy, develop evidence-based appeal strategies, and draft payer-ready documentation to overturn denials and...

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...

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.

About This Role The Utilization Management Nurse Consultant utilizes clinical experience to assess, plan, implement, coordinate, monitor, and evaluate healthcare services for members. This role is ideal for those looking to contribute to...

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...

Novitas Solutions, Inc. seeks a Clinical Review Nurse to review and substantiate medical determinations for health claims. You will assess medical necessity, service levels, and appropriateness of care under national and local policies,...

Prior Authorizations Nurse (RN) (Temporary) Remote in California OUR COMMITMENT TO A HUMAN HIRING PROCESS We believe every candidate deserves thoughtful consideration.That'swhy we do not use AI or automated...

The Virtual Nurse, RN at MUSC coordinates and delivers professional clinical, quality, and educational services to patients engaging with MUSC via virtual care. This role reports to leadership within the MUSC Center for Telehealth and aims to...

TEEMA is seeking an RN with 3+ years of clinical experience for a remote role in the United States. The position emphasizes medical record review, quality assurance, and collaboration with medical leadership. The role requires strong...

Cincinnati Children's is seeking a Utilization Review professional to perform admission and continued stay reviews to determine medical necessity and certification for inpatient stays. The role requires RN licensure with relevant experience and...

InterceptCare is seeking an experienced RN/LPN to advocate for employees and their families, guiding them through complex health plans and care options. You will partner with employers, providers, and PBMs to remove barriers and ensure members...

Nursing Attendant On Call Days (P)Under the direct supervision of a Registered Nurse or physician, performs a variety of patient care functions as assigned and in accordance with the legal scope of competency and within established standards of...

Army Public Health Nurse Job Overview As an Army Public Health Nurse, you'll assess health risks and implement programs to monitor the spread of disease. You'll promote wellness for Soldiers and their families while also informing policy and...

Machinify is seeking a Medical Review Nurse to perform CMS/RAC audits for government payers. This remote role involves working with a multi-location team to review claims, document findings, and support appeals. RAC certification is preferred and...

Remote Patient Monitoring (RPM) Nurse – Remote Join Our Growing Clinical Team! We are seeking compassionate, detail-oriented Registered Nurses (RNs) or Licensed Practical Nurses (LPNs) to join our Remote Patient Monitoring...

Exceptional care starts with exceptional people. For us, this is more than a job– it's a calling. It's waking up each day, looking for ways to make a difference with a compassionate, inclusive and talented team. Ochsner empowers...

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,...

State of North Carolina - Health & Human Services in North Carolina seeks a Nurse Consultant I who conducts regulatory nursing home inspections to ensure compliance with federal and state standards. The role involves travel across Central and...

Baptist Health is seeking a Clinical Documentation Specialist to join our team. This remote position requires residence in Kentucky or Indiana and focuses on evaluating physician documentation to ensure severity of illness is accurately portrayed...

A healthcare services provider is seeking a Remote Utilization Review Nurse to coordinate clinical resources, ensuring compliance with healthcare standards. Responsibilities include processing authorizations, reviewing documentation, and...

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...

About the job Mercor connects elite creative and technical talent with leading AI research labs. Headquartered in San Francisco, our investors include Benchmark , General Catalyst , Peter Thiel , Adam D'Angelo , Larry Summers , and Jack Dorsey .