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CVS Health is seeking a Nurse Consultant for Utilization Management in a 100% remote capacity. The role reviews inpatient and outpatient services using evidence-based criteria, authorizes care with providers, and escalates cases as needed.

Elevance Health seeks a Nurse Case Manager I to perform telephonic and on-site care coordination for members with complex health needs. The role supports plan adherence, discharge planning, and cross-functional collaboration with medical directors...

About the Job This position reports to the Enhanced Care Management (ECM) Program Manager this position provides support to the ECM Program to ensure engagement, enrollment and follow up on members related to the ECM as well as other...

Brundage Group is seeking a Utilization Review Nurse for a PRN weekend shift in a fully remote Florida role. The UR Nurse reviews admissions and continued stays to ensure medical necessity and payer compliance, collaborating with physicians and...

Revive Therapeutic Services seeks a Nurse Case Manager to oversee patient care plans and coordinate services for individuals facing health challenges. You will collaborate with patients, families, and providers to ensure effective care delivery.

Elevance Health is seeking a Nurse Case Manager II to coordinate care for members with complex needs across multiple states. The role includes telephonic and on-site discharge planning, collaboration with Medical Directors, and development of care...

Elevance Health is seeking a Utilization Management Representative I to coordinate precertification and prior authorization reviews. This full-time role supports calls, post services work, and data entry into the UM system with accuracy and...

Our promise to you: Joining AdventHealth is about being part of something bigger. It's about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is...

nirvanaHealth, a RxAdvance Corp. company, seeks a part-time Utilization Management Nurse for a remote role in the United States. You will perform prospective, concurrent, and retrospective medical necessity reviews and care coordination to ensure...

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,...

CorVel Corporation is seeking a Utilization Review Case Manager for a fully remote role in the United States. The position requires current nursing licensure and 4+ years of clinical experience with preferred exposure to utilization review.

Clinical Documentation Integrity Specialist Evaluates the day to day documentation practices of the Medical Staff and healthcare team on a complex patient population, and offers education and recommendations in accordance with the...

Job Title: Registered Nurse (RN) Disease Manager Job Overview: The Registered Nurse (RN) Disease Manager is responsible for coordinating care and managing the health outcomes of patients with chronic or...

Utilization Review Nurse - RN | 100% Remote | Part-Time 10-20 Hours Per Week | Flexible Schedule | Evenings & Weekends Looking for a way to use your nursing experience without returning to a full-time bedside...

Remote Registered Nurse – Clinical Review Fully Remote | $48–$65/hr | Monday–Friday, 9:00 AM–6:00 PM ET Medix is supporting a healthcare technology organization that is adding experienced RNs to its clinical...

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...

CVS Health is seeking a Nurse Consultant for a 100% remote role. You will apply clinical judgment and evidence-based criteria to review inpatient and outpatient services, authorize care, and escalate cases as needed, while coordinating with...

JOB DESCRIPTION Job Summary Work Location: California - Ability to work remote, but selected candidate must reside in the state of California. This position requires California RN Licensure. Candidates must...

UnitedHealth Group's Optum Care at Home is hiring a Telephonic RN Case Manager to serve as primary contact for members with complex needs, conducting telephonic assessments, creating care plans, coordinating transitions, and addressing barriers to...

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...

Back RN/Managed Care Coordinator - Remote Healthcare Columbia , South Carolina Contract Hybrid Oct 9, 2026 RN/Managed Care Coordinator - Remote Job at a Glance Title:RN/Managed Care...

Santa Barbara Cottage Hospital is seeking an experienced RN/LPN to perform remote clinical reviews for appeal cases. You will review medical records, apply InterQual criteria, and prepare clinical determinations for physician review. The...

*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...

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...