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Absolute Elder Care is seeking a Remote Nurse Consultant to provide expert guidance and support for in-home senior care. This full-time, remote role involves collaborating with families to manage health care needs, conducting comprehensive...

Comagine Health is seeking an experienced Registered Nurse to serve as a Clinical Reviewer for the Washington Labor & Industries (L&I) contract. This remote role utilizes nursing expertise to evaluate medical necessity and quality of care,...

Full-time Company Description WHO IS GUIDEHEALTH? Guidehealthis a data-powered, performance-driven healthcare company dedicated to operational excellence. Our goal is to make great healthcare...

Centene Corp. is seeking a fully remote nurse reviewer to evaluate concurrent care plans and determine appropriate levels of care for members. The role prefers an active NY State RN license and requires availability Monday–Friday, 8:30 AM–5:00...

River Valley Child Development Services Inc seeks a Child Care Nurse Health Consultant to provide technical assistance and develop trainings on health, safety, and nutrition for childcare providers in WV. This exempt, full-time role offers remote...

About This Role As a Clinical Grievances Nurse, you will review incoming retrospective cases to determine if appropriate care was given and ensure members' immediate needs are addressed. This role is ideal for those who can work PST hours...

American Health Plans, a division of Franklin, Tennessee-based American Health Partners Inc. owns and operates Institutional Special Needs Plans (I-SNPs) for seniors who reside in long-term care facilities. In partnership with nursing home...

APremium Healthcare Solution, LLC is seeking a Virtual Nurse Consultant to provide remote nursing guidance and care coordination from a flexible, virtual setting in Conyers, GA. The role emphasizes high-quality patient outcomes and HIPAA-compliant...

Peraton is seeking a Nurse Reviewer to join SafeGuard Services (SGS) and conduct medical record reviews, applying clinical judgment to claim payments. The role supports fraud investigations and referrals, with opportunities to develop cases for...

The Utilization Management Registered Nurse at Humana interprets clinical data to support coordination, documentation and communication of medical services and benefit determinations for post-acute care. You will collaborate with physicians,...

A healthcare staffing company is seeking a Clinical Review Nurse for Prior Authorization Review. This remote role demands conducting reviews, collaborating with healthcare teams, and ensuring compliance. Candidates need an active RN license and...

University Health is seeking a Utilization Management Nurse RN for UH Truman Medical Center in Missouri. The role manages resource use, supports care transitions, and advises care teams on documentation and discharge planning to improve patient...

Job Responsibilities and Requirements KEY RESPONSIBILITIES *other duties as assigned* Job Summary: Reviews all medical (and other) documentation in claim files to answer the specific...

A leading health care provider is seeking a Massachusetts Telehealth Nurse to assist patients in accessing care through phone consultations. Candidates must have a valid RN license in Massachusetts and 3+ years of clinical experience. The ideal...

AccentCare, Inc. is seeking a Hospice Triage Registered Nurse for a remote, full-time position with nights and weekends coverage. Compensation ranges from $34.00 to $37.00 per hour based on experience, with eligible benefits for employees working...

Role Title: Registered Nurse Role Type: Contractor Location: United States, Remote We are engaging Registered Nurses to contribute their expertise to a dynamic project for a valued customer. In this role,...

Public Consulting Group in Oklahoma seeks a Client Success Partner for EDPlan Innovations – EDPlan Health. This role focuses on engaging client stakeholders, managing relationships, and delivering training on the EDPlan Health system for end...

Get AI-powered advice on this job and more exclusive features. This range is provided by The Judge Group. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more. Base pay range...

Health Care Service Corporation is hiring a Nurse Liaison I for Utilization Management & Quality Review. This remote nationwide role supports clinical review activities, benefit determinations and medical necessity assessments, ensuring compliant,...

CVS Health is seeking a QM Nurse Consultant to apply specialized clinical knowledge and drive quality improvement across patient care. The role emphasizes data analysis, regulatory compliance, and developing quality assurance programs, with a...

WellSky is seeking a registered nurse to conduct telephonic patient evaluations for multiple payer programs, working on Pacific Time hours. The role emphasizes remote care coordination, schedule management, and collaborative protocol development.

Nurse Evaluator IV The Department of Health Care Services (DHCS) is the backbone of California's health care safety net. Our success is made possible by the hard work of more than 4,800 DHCS team members, as well as through collaboration...

Cleveland Clinic Homecare is seeking an experienced LPN to visit patients in their homes across the Akron and Greater Cleveland area. You will provide direct patient care, administer medications within scope, and coordinate with an...

Comagine Health is seeking a Clinical Reviewer (RN) remotely to support Washington state contracts. The role evaluates medical necessity and quality of care, collaborating with physician consultants and internal teams to ensure compliant,...

Georgia Department of Community Health (DCH) is seeking a Compliance Nurse 2 for the Long-Term Care Unit to perform on-site surveys and document review. The role requires extensive travel (up to 90%), and prior RN experience with supervisory...