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A leading healthcare provider is urgently seeking experienced Clinical Documentation Specialists for remote positions. Ideal candidates must be RN graduates from an approved nursing program and possess prior CDI experience, preferably in acute...

A healthcare staffing company is seeking a Registered Nurse in Columbia, SC for a 3-month assignment with potential for conversion. The role includes evaluating medical eligibility for benefits, providing health management interventions, and...

The Itemization Review Nurse provides a summary and analysis of items by reviewing all charges on a UBIB submitted by a medical facility to determine accuracy of billed charges. This is a remote position. ESSENTIAL...

Description Join PeaceHealth in advancing compassionate, mission-driven care from wherever you are. PeaceHealth is looking for a skilled and motivated Registered Nurse Utilization...

Job Description Job Summary Provides support for medical claim and internal appeals review activities - ensuring alignment with applicable state and federal regulatory requirements, Molina policies and...

A leading digital health company in Atlanta is seeking a Care Manager to provide high-quality telephonic case management for members. This role involves developing plans of care, collaborating with healthcare providers, and ensuring positive...

Overview What you can expect! Find joy in serving others with IEHP! We welcome you to join us in "healing and inspiring the human spirit" and to pivot from a "job" opportunity to an authentic...

A healthcare organization is seeking an Adjunct Instructor (Online Contract) to oversee distance education courses in Newport News, Virginia. The instructor will support student outcomes through effective instructional design and accountability...

Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy. AZ Blue offers a variety of health insurance products and services to meet the diverse needs of individuals, families,...

Position Purpose The Transfer Center & Virtual Care RN provides leadership, accountability, and comprehensive nursing services to ensure optimal patient care, resource utilization, and seamless patient flow. This role is challenged...

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

Discover. Achieve. Succeed. #BeHere Location: US:WI:MENOMONEE FALLS at our CP-NORTH HILLS HEALTH CENTER facility. This job is ON - SITE. FTE: 0.400000 Standard...

A leading not-for-profit health insurer is seeking an Appeals Nurse to analyze medical records and claims for appeals. The role requires an RN license and 1+ years in clinical settings. Responsibilities include determining medical necessity and...

divh2Job Summary/h2pThe RN Care Review Clinician provides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance...

Description Location: UCHealth Anschutz Inpatient Pavilion - Aurora Department: Virtual Health Center - Quality program This position is an onsite role and does not offer a hybrid or remote...

Responsibilities The Phone Triage Registered Nurse provides skilled nursing telephone triage for participants experiencing medical concerns during nights, holiday and weekends in accordance with InnovAge...

Deep Roots. Solid Growth. Caring People. Rooted in Wyoming! We are Blue Cross Blue Shield Wyoming: a not-for-profit health insurer with offices throughout the state. Ever since a small group of caring,...

A leading health services company is hiring a Clinical Review Nurse to conduct concurrent reviews and evaluate the health care provided to Iowa Medicaid members. The role allows remote work anywhere in the Central time zone and requires an Iowa or...

In order to have an accurate count of participants, we need you to register for the Recruitment Fair on the District's website. Please select "apply for this position" under the heading to the right labeled "Apply Now". Interviews slots will fill up...

Duration: 3+ Months (Possible contract to hire) Job Description: Onsite training - will last up to six weeks but could be extended. A typical day would like in this role: Process prior...

Summary We are currently hiring for an Appeals Analyst to join BlueCross BlueShield of South Carolina. In this role as Appeals Analyst, you will research the substance of complex appeal or retrospective review requests...

HJ Staffing is partnering with Impresiv Health, a specialized healthcare consulting partner, to find a dedicated and detail-oriented Utilization Management Registered Nurse (UM RN). This critical...

Your Future Evolves Here Evolent partners with health plans and providers to achieve better outcomes for people with most complex and costly health conditions. Working across specialties and primary care, we seek to connect...

The range for this role is $25 - $34.13 Actual base pay will be determined based on a successful candidate's work location, skills/abilities, experience, and education. Interested applicants...

A national health insurance company is seeking a Prior Authorization RN to review clinical appropriateness of prior authorization requests. This role is pivotal in ensuring compliance with Medicare and Medicaid criteria, while improving the...