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Health Care Service Corporation seeks a Quality of Care (QOC) Nurse to review and investigate potential quality of care issues in a timely manner. This role supports QA activities in line with CMS and NCQA requirements, under the supervision of...

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...

American Health Plans Franklin, TN 37067, USA Description American Health Plans, a division of Franklin, Tennessee-based American Health Partners Inc. owns and operates Institutional Special Needs Plans (I-SNPs) for seniors...

Eliot Community Human Services, Inc. is seeking a Nurse Manager to join the CBHC Child Team, providing leadership and clinical oversight for medical and psychiatric services. You will supervise nursing staff, coordinate care, and ensure...

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,...

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...

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...

A technology and business consulting firm is seeking a Clinical Medical Review Nurse to analyze health data and provide insights for internal stakeholders. The ideal candidate has a Registered Nurse license, along with four years of clinical...

PIH Health in Los Angeles is seeking an RN Peer Review Analyst responsible for retrospective medical record reviews, data compilation to validate quality and accuracy of documentation, and auditing charts for admission/continued stay. You will...

Central California Alliance for Health is seeking a Prior Authorizations Nurse (RN) for a temporary, full-time role. This remote-in-California position reports to the Utilization Management Supervisor and involves ensuring PA requests comply with...

Care Management Nurse Consultant Competitive Compensation & Benefits Package! Position eligible for: Annual incentive bonus plan Medical, dental, and vision insurance with low deductible/low cost health plan...

McLaren Health Care is seeking a Registered Nurse to join the Utilization Management team. The role focuses on determining appropriate patient status, ensuring medical necessity, and documenting care for insurance and government payers within an...

Registered Nurse (RN) - Utilization Management 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...

The Lupus Foundation of America is seeking a Clinical Trial Nurse/Nurse Navigator to support lupus trials as a contractor. This role links patient education, screening, enrollment, and ongoing support with academic centers, focusing on...

CVS Aetna 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...

Guardian Life is seeking an RN Clinical Consultant to serve as a clinical expert in evaluating short-term and long-term disability claims. You will analyze medical information, assess functional capacity, and collaborate with healthcare providers...

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,...

Jobgether SRL is seeking a part-time remote clinical support professional to assist a Canada-wide healthcare team. You will provide essential clinical and administrative support across Canada, coordinating with laboratories, pharmacies, referrals,...

PACE Early Childhood Education Program Consultant PACE Early Childhood Education (ECE) Program provides high quality early childhood education and support services for children aged 0-5 years old children for economically disadvantaged...

Find your calling at Mercy! Position Details: Primary Care Nurse RN or LPN Mercy Clinic Primary Care - Quailbrook (OKC) Monday-Friday, 40 hours per week *This is a hybrid remote position. The person hired for this role will...

CVS Health is seeking an experienced Registered Nurse for a remote Utilization Management Nurse Consultant role focused on Medicare joint procedures. You will review clinical information for precertification, apply criteria, and collaborate with...

It takes great medical minds to create powerful solutions that solve some of healthcare's most complex challenges. Join us and put your expertise to work in ways you never imagined possible. We know you've honed your career in a fast-moving...

Medica, a nonprofit health plan, seeks a Clinical Quality Review III (RN and Certified Coder) to conduct medical record reviews, data collection, and clinical audits across its network. You will assess documentation accuracy, adherence to clinical...

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...

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...