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Supports the values of service excellence, teamwork, and integrity while managing patient care. Acts as a liaison among patients, caregivers, multidisciplinary teams, and payers. Qualifications: Requires a...

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.

ISYS Case Management is seeking a Telephonic Case Manager (RN, RN-BC) to operate remotely from Tampa or surrounding areas. You will provide telephonic case management for injured workers, coordinating care with providers, carriers, employers and...

INTEGRIS Health in Oklahoma City, OK is seeking an experienced RN Case Manager for Utilization Review to join our remote team. This full-time daytime role includes every-other-weekend shifts and focuses on coordinating care and discharge planning.

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...

CorVel Corporation is seeking a Utilization Review Case Manager for a remote role. The ideal candidate holds an RN license and has 4+ years of clinical experience with utilization review, CPT/ICD coding knowledge, and strong communication skills.

Company Overview At Enlyte, we combine innovative technology, clinical expertise, and human compassion to help people recover after workplace injuries or auto accidents. We support their journey back to health and wellness through our...

Job Title: Clinical Quality Assurance Nurse Pay: see below Registered Nurse - $28.50/hr (Non-negotiable) LPN/LVN- $26.50/hr (non-negotiable) Regular Schedule after training: M-F...

A leading healthcare staffing firm in Florida seeks a dedicated RN for telephonic care management. The ideal candidate will have over 2 years of clinical nursing experience in an acute care setting and proficiency in case management.

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...

The Elevance Health Companies, Inc. in California is seeking a Telephonic Nurse Case Manager II to assess, plan and coordinate care for members with complex needs. This hybrid/remote role allows remote work with required in-person training...

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...

Our client, a mutual benefit corporation and health plan provider, seeks an accomplished Registered Nurse (Utilization Management). *** Candidate must be authorized to work in USA without requiring sponsorship...

Our Story Imagine being part of a team that's not just shaping the future but actively driving it. At Davies North America, we're at the forefront of innovation and excellence, blending cutting-edge technology with top-tier...

HonorHealth in Phoenix is seeking an Utilization Review RN Specialist to review and monitor utilization, ensuring medically necessary care and appropriate discharge planning within Medicare, AHCCCS, Self-pay, and other payer guidelines. The...

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...

Centene is seeking an RN with strong appeal review experience to act as liaison for statewide appeals, fair hearings, and review organizations. This fully remote role supports members and providers while ensuring compliance with State and NCQA...

Sedgwick is seeking a US Telecommuter RN Telephonic Case Manager for a full-time remote role. You will support injured workers, employers and providers, coordinating medical services and advocating for timely recovery and return-to-work.

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...

Health Plan of San Joaquin is seeking a Case Manager Nurse for a remote position. Candidate must reside in California and have a valid California RN license with 3+ years of RN and case management experience. You will conduct case...

Immediate need for a talented Utilization Management RN - Prior Authorization. This is a 12+ Months Contract opportunity with long-term potential and is located in US (Remote). Please review the...

Brighton Health Plan Solutions is seeking an experienced Utilization Management Nurse to perform medical necessity and benefit reviews remotely, supporting both inpatient and outpatient cases. The role requires an active LPN license, strong...

EK Health is hiring a Full-Time Telephonic Nurse Case Manager (RN) for the Case Management Team. You will assess, plan, implement, coordinate, and evaluate service options to help injured workers receive timely, cost-effective care and return to...

CVS Health's Aetna team is seeking a Case Management Coordinator to support dual eligible members across the country. This remote role requires travel within Kane and DuPage Counties and surrounding areas, focusing on coordinating benefits and...

About This Role The Optumcare Medical Behavioral Integration Nurse Case Manager (MBI NCM) serves as a direct clinical liaison between OptumCare and the clinical network, focusing on assessing, planning, implementing, coordinating,...