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Renown Health is seeking a Utilization Management RN to apply medical necessity criteria for prospective and concurrent reviews. You will work with an interdisciplinary team to ensure medically necessary, cost-effective care at the appropriate...

Humana is seeking a Pre-Authorization Nurse to review requests for medical necessity and level of care, working remotely from Virginia or a compact-licensed state. You will educate providers, document clinical data, and make independent...

Family Advocate Support Care - Senior Clinical Admin Nurse At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of...

*This role will require the successful candidate to work the shift of Monday to Friday, 1pm to 10pm Central (2pm to 11pm Eastern). The Utilization Review Clinician is responsible for reviewing medical records to determine medical necessity. This...

Behavioral Health Utilization Reviewer The Behavioral Health Utilization Reviewer is responsible for conducting clinical reviews of behavioral health service requests, claims, and appeals to confirm medical necessity and appropriateness...

Ansible Government Solutions, LLC is recruiting multiple Remote Registered Nurse Case Managers to support the VA Office of Veterans Community Care. The role involves managing SEOC data, ensuring compliance, and reviewing provider and veteran...

WelbeHealth PACE helps seniors stay in their homes and communities by providing comprehensive medical care and community-based services. We serve the most vulnerable seniors with better quality and compassion in a value-based model.The Case...

McLendon Leadershi in Glendale, CA is seeking a Case Manager Nurse to coordinate patient care across hospital and home health settings, optimize utilization, and support smooth transitions for patients. The ideal candidate will bring expertise in...

Longevity Health is seeking an experienced ISNP Utilization Management Nurse to join a remote clinical team. You will review medical records to determine the medical necessity of inpatient and outpatient services, applying InterQual/MCG criteria...

Job ID: 33380 *Description*There's nothing more exciting and rewarding than being able to make a significant, positive difference in someone's life. At UCLA Health, you'll experience this joy every day while also enjoying the positive,...

Summary: Uniti Med is looking for a (LPN/LVN) Licensed Practical/Vocational Nurse in Los Angeles, California. This assignment lasts 13 weeks and is scheduled to start on 10-19-2026.

Compliance Nurse Trillium Health Resources is a Tailored Plan and Managed Care Organization (MCO) serving 46 counties across North Carolina. We manage services for individuals with serious mental health needs, substance use disorders,...

Kingman Healthcare Incorporated (KHI)Staff Position Description Position Title: Utilization Review Nurse Position Code: RN-6027 Department: Case Management Safety Sensitive: Yes...

Managed Medical Review Organization is seeking an RN to join the team in a remote, home-office role. The position emphasizes telephonic/customer service skills, meticulous documentation, and solid clinical experience, with no face-to-face patient...

Find your calling at Mercy! The Nurse Navigator is a leader providing support, mentorship, and guidance to those who provide direct patient care. The Nurse Navigator coordinates the delivery of patient care by...

Description: Job Summary: Works collaboratively with an assigned panel of physicians to manage the patients specialized needs. The managing team does differ according to the chronic disease. Duties include assessment to identify...

AltaMed Health Services Corp. in Commerce, CA seeks an LVN Case Manager to coordinate care for hospital and SNF patients, with emphasis on inpatient and ambulatory management.The role requires valid LVN licensure, 3+ years in related fields, and...

Responsive Recruiter Benefits: Competitive salary, opportunity for advancement, paid time off, training & development, wellness resources. This role is in-person in our office, located in Lake Balboa. Position Purpose The...

Spectrumforce Technologies, Inc. is seeking a Care Manager (RN) to support Medicaid members remotely in Florida. The role involves reviewing referrals, proactive outreach, and guiding members through care management, education, and coordinated...

MAJOR RESPONSIBILITIES/ESSENTIAL FUNCTIONSThe primary job duties this position is responsible for achieving are listed in order of importance.Job Summary:To facilitate a safe discharge and/or transition of care for patients from hospital, lower...

Job ID:26-134888 Job Title: Licensed Vocational Nurse Position Type: Full-Time Contract Role Location:Fully Remote Work Type: Work from Home Est. Pay Range: $25.00/Hour to $28.00/Hour on W2 (USD) Schedule: 8-hour shift Monday to Friday anywhere...

Clinical Specialist As a Clinical Specialist, you will use your practical or vocational nursing experience and knowledge of medical and behavioral health conditions to support timely disability claim decisions. You will identify and...

Integra Partners seeks an experienced Utilization Management Nurse Supervisor to lead the UM nursing team, ensuring performance, accountability, and professional development. You will conduct regular 1:1s, manage performance reviews, and drive...

Details Client Name CSMN - 8714016 - Outpatient Ambulatory Care Job Type Travel Offering Nursing Profession Nursing...

Authorization Nurse Do you have clinical care experience? Are you an RN looking to grow your career? UPMC is hiring a full-time Authorization Nurse. This position works Monday through Friday, as well as rotating weekends (typically 1...