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Sentara Health Plans seeks a Clinical Claims Reviewer RN for remote work. You will perform utilization management, review pre/post payment claims and authorizations for inpatient/outpatient cases, and address provider inquiries with appropriate...

Arkansas Blue Cross Blue Shield is seeking an experienced Utilization Management Nurse to perform clinical reviews for prior approvals, benefit inquiries, and inpatient/outpatient services. This role requires interpreting evidence-based criteria,...

Ochsner Health, a leading not-for-profit healthcare provider in the Gulf South, seeks an experienced RN for a remote case management role. You will coordinate care by liaising with patients, caregivers, multidisciplinary teams, and payers to...

This is a fully remote position, open to candidates based in United States. Pay: $60–$70/hr Role Title: Registered Nurse Role Type: Contractor Location: United States,...

Case Manager RNLos Angeles, CA$2465 /Weekly Gross**Estimated pay package. Does not include taxes, insurance, or other deductions that may occur11/2/202610H Days4 Weeks40Short Term Acute Care HospitalEPICRequirementsAt least 2+ years'...

American Health Plans Franklin, TN 37067, USA Description American Health Plans, a division of Franklin, Tennessee-based American Health Partners Inc. owns and operates Institutional Special Needs Plans (I-SNPs) for seniors...

Hines & Associates, Inc. seeks a Registered Nurse reviewer to assess patient conditions and certify treatments according to URAC and applicable regulations. The role emphasizes clinical judgment, documentation, and collaboration with case managers...

CVS Health is seeking an RN Case Manager to join Community Care. You will coordinate and advocate for patient care, collaborating with providers to address needs along the care continuum. Qualified candidates hold an active Compact RN...

Description Job Title Nurse Case Manager 2 Location Remote - OK Position Description The Case Manager utilizes a collaborative process of...

Job Title: Utilization Management Registered Nurse (UM RN) – SNF / MLTC Location: Remote (Must reside in NY, NJ, or CT) Schedule: Monday – Friday, 9:00 AM – 5:00...

Required Skills & Experience • Active RN license (Compact license required)\n• 2–4 years of clinical experience (neurology and/or endocrinology experience preferred)\n• Strong interest in chronic disease management across neuro and...

HealthEdge is seeking a motivated Utilization Review RN to join our team. You will perform prospective, concurrent and retrospective reviews of inpatient, outpatient, ambulatory and ancillary services to ensure medical necessity, length of stay...

Case Manager We're building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you'll be surrounded by passionate colleagues who care deeply, innovate...

Overview Our client is a trusted leader in healthcare services, dedicated to improving outcomes for patients and providers through innovative solutions and high-quality care. Join a team committed to making a meaningful difference in the...

Clinical Liaison (RN/Allied Health Professional) Location: Remote (covering PA and NYC) Employment Type: Part-Time - Weekend Coverage 9a-5p Compensation: $55-$60/hr The Role Are you an...

Description RN- Registered Nurse - Case Manager Specialty: Case Manager Location: Los Angeles,CA,00000 Start Date: 2026-10-19 End...

CorVel is seeking a Utilization Review Case Manager to gather demographic and clinical data for in-patient and outpatient reviews, certify medical necessity, and assign appropriate LOS while supporting the Case Management department's goals. This...

Registered Nurse - Case Management - Travel | Burbank, California Estimated Weekly Pay: $2790.46 Start Date: 11/09/2026 | Duration: 13 Weeks Shift: 5 x...

Overview St. Francis Medical Center is one of the leading comprehensive healthcare institutions in Los Angeles. St. Francis provides vital healthcare services for the 700,000 adults and 300,000 children in our community who count on the...

**Job Description****Professional Development Specialist - Care Management****Cedars-Sinai | Integrated Care Management (ICM) & Integrated Service Planning (ISP)****Empower People. Elevate Practice. Make an Impact.**At Cedars-Sinai, exceptional...

VIVA HEALTH in Birmingham, AL is seeking a Case Manager, Utilization Review to support members and high-risk patients. The role involves coordinating utilization review activities, performing timely medical records checks, and determining medical...

Fully remote (never coming onsite) Description: The Case Manager utilizes a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual's benefit plan...

JOB REQUIREMENTS: -Experience: 3 years acute care case manager experience -CA RN License -Certs: BLS -**FLU VACCINE (no exemptions)** Flu season starts September -Special Requirements: EPIC highly preferred. Due to nature of...

Nurses - are you looking for a change? Want to work no nights, and no holidays? Check out Hines & Associates! ABOUT US: Hines is a nationwide, independent leader in personalized managed health care,...

SCM Associates, Inc. seeks an experienced Case Manager (RN) to assess, plan, coordinate, and monitor care for clients in a home-based setting. You will collaborate with families, physicians, and the care team to ensure quality, cost-effective...