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Include:Serve as the primary point of contact and advocate for patient care, ensuring a seamless and proactive healthcare experience. Develop, implement, monitor, and revise individualized care plans in collaboration with the physician and other...

Elevance Health is hiring a Nurse Care Manager I to work virtually, focusing on personalized health management for plan beneficiaries. Responsibilities include providing quality case management, conducting clinical assessments, and ensuring...

Job Description: The Intake Coordinator is a Registered Professional Nurse who takes referrals and processes appropriate home care services. To maintain open lines of communication with referral sources and within Americare...

L.A. Care Health Plan in Los Angeles is hiring a Utilization Management Claims Review Nurse RN II responsible for conducting clinical reviews of medical claims. The position requires a minimum of 5 years in clinical nursing, with experience in...

Evenings, Weekend Only, Full-time & Part-time opportunities available (20hrs +) Hiring for evenings and weekends (*weekends and holidays are required) Incentives for Bilingual Spanish Telephone Triage RNs! Are you looking for an...

DescriptionThe Utilization Review Nurse is part of the Utilization Management Department at the Resnick Neuropsychiatric Hospital, supporting inpatient, partial hospital, and intensive outpatient programs. Performs clinical reviews with third...

Regional MDS / PDPM / CMI / RAI Consultant Are you ready to make a change? We are seeking an experienced Regional MDS / PDPM / CMI / RAI Consultant to provide remote reimbursement, MDS, PDPM, Case Mix Index, and RAI support to our...

RN Clinical Documentation Improvement Specialist This is a REMOTE opportunity Your experience matters: Frye Regional Medical Center, located in the beautiful foothills of North Carolina is a 355-bed acute care hospital,...

AccentCare in Glendale, CA is seeking a Clinical Patient Family Liaison, Registered Nurse to join its dedicated team. This role involves managing patient family information, communicating with healthcare providers, and assisting in medical...

RN Utilization Mgmt Full-Time Day POSITION SUMMARY The RN Utilization Management (RN UM) functions as a support liaisons for a variety of UM functions which may include: the e-TAR process, denials management,...

RN / LVN Regional Clinical Liaison - Los Angeles, CARESPECT. RELIABILITY. POSITIVE ATTITUDE. ALWAYS MOTIVATED. HUMILITY.These are some of Skilled Wound Care's core values; we are seeking the absolute best people in healthcare to help us change the...

Please contact: To discuss this amazing opportunity, reach out to our Talent Acquisition Specialist Nikhil Jhajharia at email address [email protected] can be reached on # 630-576-1935. We have...

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh...

DescriptionTake on a high-impact role within a world-class health organization. Help drive the continued delivery of exceptional patient care. Take your career to the next level. You can do all this and more at UCLA Health.As a Manager for...

Complex Medicare Claims Review Complex Medicare claims/prior authorization requests require the review of medical record documentation to determine the reasonableness and necessity of the billed service in accordance with Medicare rules...

NeueHealth is a value‑driven healthcare company grounded in the belief that all health consumers are entitled to high‑quality, coordinated care. By uniquely aligning the interests of health consumers, providers, and payors, we help to make...

The University of Southern California (USC), founded in 1880, is the largest private employer in the City of Los Angeles. As an employee of USC, you will be a part of a world-class research university and a member of the "Trojan Family," which is...

Primary Duties and ResponsibilitiesTake on a high-impact role within a world-class health organization. Help drive the continued delivery of exceptional patient care. Take your career to the next level. You can do all this and more at UCLA...

Nurse Reviewer – State of Illinois Location: Remote with on-site visits across Illinois We are currently seeking Nurses who reside in Central Illinois - preferably in McLean and Sangamon Counties. Position Overview...

UnitedHealthcare is seeking a Registered Nurse to join their team, where you will perform initial assessments of appeals and manage records. This role offers a flexible remote option, with a schedule primarily from 8-5 EST or CST.You're expected...

Utilization Review Rn 1st time ok/ 2 yr exp required for utilization review rn every other weekend required or more depending on unit needs no call or floating required must have experience with milliman care guidelines and acute hospital...

Scion Nonprofit Staffing has been engaged to conduct a search for a Registered Nurse (RN) - Research for a mission-driven clinical research organization advancing equitable healthcare access and innovative treatment...

Job Opportunity At CVS Health 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...

Remote Rn – Medical Claims Reviewer At Broadway Ventures, we transform challenges into opportunities with expert program management, cutting-edge technology, and innovative consulting solutions. As an 8(a), HUBZone, and Service-Disabled...