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**Job Description**Do you have a passion for the highest clinical quality and patient happiness? Would you like to use your expert clinical competencies with an organization known nationally for excellence in cancer treatment, research and...

The Fountain Group is seeking a licensed RN for a 100% remote, 40-hour week contract role to support medical device safety activities, with emphasis on adverse event processing and regulatory compliance. You will review and escalate...

Cohere Health seeks an experienced RN Reviewer to perform prospective, concurrent, and retrospective reviews ensuring medical necessity and high-quality care. You will collaborate with Medical Directors, providers, and cross-functional teams to...

Claims Medical Review Nursing Consultant Job No: 544045 Work Type: Full-time Location: REMOTE OPTIONS, VARIOUS-STATEWIDE, PHOENIX Categories: Healthcare/Medical Support Level,...

Cambia Health Solutions is seeking an experienced Utilization Management Nurse to support our Clinical Services team. You will perform prospective, concurrent, and retrospective reviews to ensure medical necessity and appropriate care, while...

This RN will act as a Care Manager supporting our Michigan Medicaid members, identified with complex medical needs. The Medicaid Care Manager will support them to ensure a successful health outcomes. The position includes telephonic...

Highpoint Health Sumner is seeking a Registered Nurse (RN) Clinical Documentation Specialist to join as a remote FT (days). You'll contribute by applying plan-of-care interventions and driving patient-care innovations with advanced technology.

The U.S. Department of Veterans Affairs is seeking a Remote Patient Monitoring (RPM) Home Telehealth RN Care Coordinator for the Central Arkansas Veteran Healthcare System in Little Rock, Arkansas. The role emphasizes leadership...

OpTech is seeking a Registered Nurse (RN) to support utilization review and clinical review activities for a Michigan health plan. This role involves evaluating medical services for medical necessity, level of care, and clinical criteria. The...

About This Role The Clinical Consultant RN, Medical Policy Writer role at UnitedHealth Group involves providing clinical leadership for assigned Optum products, focusing on the development of clinical utilization management guidelines and...

Saint Joseph Health System is seeking an RN Utilization Review specialist for a part-time, remote PRN role that requires on-site training in Mishawaka, Indiana. The position emphasizes reviewing medical necessity, insurance requirements, and...

*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...

JOB DESCRIPTION We are searching for six TX licensed RNs to work telephonically with our Medicaid members across the state. Three of the positions are open to RNs with at least two years of experience in in Behavioral Health or Substance...

Oscar Health is seeking a Utilization Review Nurse to join our team. You will review cases, verify medical records, and consult with care providers to assess treatment appropriateness using Oscar Clinical Guidelines, MCG, and InterQual. The...

Comagine Health in Alabama is seeking Clinical Utilization Review Nurses (RN) to assess medical necessity and quality of care through prospective, concurrent, and retrospective utilization reviews. This is a full-time remote role supporting...

Legal Nurse Consultant (RN) – Contractor Apply your clinical expertise to the intersection of healthcare and legal services as a Legal Nurse Consultant. In this role, you will support attorneys by analyzing medical records, evaluating...

Cincinnati Children's is seeking a registered nurse to join the After Hours Nurse Helpline on a remote, full-time schedule with rotating weekends and holidays. The role supports patient care when offices are closed and requires adaptation to a...

Grow Healthy If you are as passionate about helping those in need as you are about growing your career, consider AltaMed. At AltaMed, your passion for helping others isn't just welcomed - it's nurtured, celebrated, and promoted,...

National Care Advisors is seeking a Nurse Case Manager in the DC/Baltimore area to coordinate case management for eldercare clients, working with families, attorneys, and trustees to support quality of life. The role emphasizes timely...

Iris Telehealth is hiring PMHNPs for 100% remote consult-liaison telepsychiatry in Texas. Earn $120/hr with a sign-on bonus, working 13–16 overnight shifts per month, including weekends. Roles require Texas PMHNP licensure, 2 years...

To support an upcoming clinical project, experienced Registered Nurses (RNs) will find a fully remote contract opportunity as a Remote RN Clinical Consultant, focusing on conducting comprehensive medical record and clinical chart reviews while...

Appeals Nurse Consultant 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...

This position is offered fully Home based (Remote) As a pharmaceutical support industry leader, UBC is devoted to empowering health solutions for a better tomorrow. We take pride in improving patient outcomes and advancing healthcare. At UBC we...

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...

The Clinical Quality Assurance Coordinator is responsible for ensuring case reports are of the highest quality and integrity, and in full compliance with client contractual agreements, regulatory agency standards and federal and state mandates.