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Vassar Brothers Medical Center in Poughkeepsie, NY is seeking a skilled Utilization Review Nurse to perform clinical reviews, determine level of care, and collaborate with physicians to ensure appropriate patient placement and regulatory...

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...

Hi. We're Hummingbird. We're elevating patient access so patients can get healthcare how, when, and where they need it. We partner with healthcare systems to transform how patients access care, enabling their providers to focus on what...

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...

Health & Human Services in North Carolina seeks a Nurse Consultant I (NS) to perform regulatory nursing home inspections, ensuring compliance with federal and state requirements and preparing deficiency reports. The role is home-based with regular...

AuthoraCare Collective is seeking an RN for our After-hours Triage department serving our Burlington and Greensboro service areas. This is a remote part-time position; Every other Saturday and Sunday 10:00am - 4:00pm. Must reside in the...

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,...

Job DescriptionJob DescriptionBilingual Remote LPN/LVN - Clinical Interviewer100% Remote | $25-$26/hour | Monday-Friday 11:30 - 8 PM EST (Can reside anywhere in the U.S. to be considered)**Must be bilingual and hold an active LPN/LVN license to be...

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...

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...

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.

Cambia Health is seeking an Utilization Management Nurse to work remotely within Oregon, Washington, Idaho or Utah. The role focuses on prospective, concurrent and retrospective reviews to ensure medical necessity and cost-effective care, applying...

About US: Tryfacta is a leading, nationally renowned Workforce Management Solution provider for private &public sector firms across the US. We specialize in Healthcare, IT, Business Support, and Professional & Craft/Light...

Centene Management Company LLC in Illinois is seeking an RN to remotely support Medicaid High Risk Maternity members. The role requires an active Illinois RN license and follows a Monday–Friday 8am–5pm Central Time schedule. You will...

Omega Healthcare in the United States is seeking an experienced RN with UR/UM leadership to drive utilization management programs. You will mentor staff, coordinate workflows, and partner with physicians and hospital leadership to optimize patient...

5K Sign On Bonus!Southwest Care Center employees can answer yes to these 3 questions: 1. Do you want to make a difference? 2. Do you believe everyone is entitled to quality healthcare? 3. Do you desire to serve the...

Case Manager RNBurbank, CA$2537 /Weekly Gross**Estimated pay package. Does not include taxes, insurance, or other deductions that may occur8H Days26 Weeks40Short Term Acute Care Hospital368EPICRequirementsAt least 2+ years' experienceEither an...

CareHarmony is hiring a Licensed Practical Nurse (LPN) in Oklahoma City to join their team in delivering value-based care management. The role involves conducting health assessments, coordinating resources for chronic care, and educating patients.

Navitus is hiring a Telehealth Registered Nurse to conduct telephonic comprehensive medication reviews (CMRs) and provide medication counseling to members. This role ensures CMS and HIPAA compliance while coordinating with healthcare providers,...

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

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...

Health & Human Services in North Carolina seeks a Nurse Consultant I (NS) to perform regulatory nursing home inspections, ensuring compliance with federal and state requirements and preparing deficiency reports. The role is home-based with regular...

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...

Kindred Hospital Los Angeles Nursing AssistantKindred Hospital Los Angeles helps patients return to the lives they love. At our hospital, our physician-led care teams provide critically ill patients with the specialized acute care 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...