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Job Summary: Provides consultation and leadership in designated areas of expertise independently. Collaborates with interdisciplinary teams and stakeholders to address issues and achieve project objectives. Coordinates advanced knowledge...

JOB DESCRIPTION Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and...

HBiz seeks a Clinical Appeals Nurse (RN) to remotely support revenue cycle operations. You will review denied claims for clinical accuracy, develop evidence-based appeal strategies, and draft payer-ready documentation to overturn denials and...

Registered Nurse Specializing In Utilization Review Join our team as a Registered Nurse specializing in Utilization Review, where you'll play a crucial role in patient care management. What You'll Be Doing Conduct...

Utilization Management Nurse Consultant (RN) – Concurrent Review Remote | Acute Inpatient Utilization Management | RN Opportunity Are you an experienced RN with a background in acute care and utilization management? Join our team...

CorVel Corporation seeks a Care Advocate Nurse for a remote role focused on assessing injury severity, reviewing medical data, and supporting the Claims Management department as a nurse consultant. The position requires clinical nursing...

CVS Health is seeking a Nurse Consultant for Utilization Management in a 100% remote capacity. The role reviews inpatient and outpatient services using evidence-based criteria, authorizes care with providers, and escalates cases as needed.

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 deeply, innovate with purpose, hold...

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

BJC HealthCare is seeking a registered nurse to join a remote Utilization Review team. The role supports multiple hospital units with no patient communication, and it is designed for local remote work with weekend rotation. Responsibilities...

The Veterans Health Administration at the Charleston VA Medical Center seeks a Nurse Manager (RN) to lead and supervise designated units within Community Care. The role emphasizes staff development, evidence-based practice, and collaboration with...

Are you an experienced MDS nurse who enjoys solving problems, supporting teams, and making an impact across different skilled nursing environments? Health Dimensions Group (HDG)—a nationally respected leader in senior care consulting and...

The position is work from home with field visits. JOB PURPOSE: This position is responsible for conducting medical management and health education programs for customers on government health care programs. Accountabilities include...

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 deeply, innovate with purpose, hold...

Humana is seeking a Utilization Management Nurse to support coordination, documentation, and communication of medical services and benefit determinations. This role suits experienced nurses who can work independently and make critical patient-care...

100% REMOTE PAY: $47-$52/hr REQUIRED: Must have current RN licensing Post market medical device experience in either medical assessment, complaint handling, post market reporting – preference is actual medical device assessment Highly prefer...

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...

JOB DESCRIPTION Job Summary Work Location: California - Ability to work remote, but selected candidate must reside in the state of California. This position requires California RN Licensure. Candidates must...

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 deeply, innovate with purpose, hold...

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...

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.

Cunningham Children's Home in Urbana, IL, is seeking a Nurse Case Manager to support youth with emotional, psychological, and physical care in residential programs. You will provide medical case management, screening, education, counseling, 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...

Benefits We Offer: Comprehensive health, prescription, dental, vision, life, and disability plans Competitive pay rates Referral opportunities ? Refer a friend & Cash in! Travel reimbursement and per diem...

Michigan Public Health Institute (MPHI) is seeking a Nurse Consultant - Tuberculosis to coordinate and enhance Michigan's TB program, connecting providers with TB experts and promoting best practices across the state. The role focuses on...