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Mitchell International is hiring a Remote Medical Claims Consultant to analyze medical records and bills for relatedness and causality for clients. You will prepare medical evidence and organize case materials while reviewing chart status and...

Alignerr is seeking a Nursing Informatics Specialist (AI Training) who brings clinical nursing expertise to evaluate and improve AI systems used in healthcare settings. Remote, hourly contract with flexible hours (10-40 hours/week), focusing on...

Remote Nursing OpportunitiesAre you looking for an exciting way to utilize your nursing skills and expertise to deliver quality nursing care in a remote setting? AccessNurse, where technology meets compassionate care, is looking for professional...

CVS Health is seeking a registered nurse to assess, plan, implement, coordinate and evaluate healthcare options for members. The role focuses on coverage determination and coordination within the utilization management framework. The...

Valeris is seeking a Patient Support Nurse to engage patients from enrollment through treatment, addressing barriers and supporting therapy initiation. You will educate on treatment, navigate insurance, and triage to additional services as needed.

CVS Health is seeking a Registered Nurse for Utilization Management to assess and coordinate healthcare services for members, applying clinical judgment and guidelines to render coverage decisions. Collaboration with providers supports care...

Exceptional care starts with exceptional people. For us, this is more than a job– it's a calling. It's waking up each day, looking for ways to make a difference with a compassionate, inclusive and talented team. Ochsner empowers you...

About This Role The Utilization Management Nurse Consultant utilizes clinical experience to assess, plan, implement, coordinate, monitor, and evaluate healthcare services for members. This role is ideal for those looking to contribute to...

Guardian Life seeks an experienced RN Clinical Consultant to evaluate disability claims, analyze medical information, and provide clinical recommendations for claim decisions. You will collaborate with providers, claimants, and staff, ensuring...

Concept Rehab & Engage Consulting is seeking an experienced MDS Nurse (RN) Coordinator for a full-time remote role. You will manage MDS assessments, ensure accurate documentation, and support reimbursement workflows for skilled nursing facilities.

Every effort has been made to identify the essential functions of this position. However, it in no way states or implies that these are the only duties you will be required to perform. The omission of specific statements of duties does not exclude...

Who We Are: Since 1985, BHCHP's mission has been to provide or assure access to the highest quality health care for all individuals and families experiencing homelessness in greater Boston. We care for over 11,000 homeless individuals each...

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...

Centene Corporation in the United States is seeking a Nursing professional to analyze prior authorization requests and determine medical necessity and level of care in line with standards and coverage. You will collaborate with medical teams to...

Northeast Georgia Health System seeks a CDI Specialist to enhance clinical documentation and ensure appropriate reimbursement for DRG-based payers. You will engage physicians, nursing staff, and coding teams to clarify documentation and improve...

CVS Health is seeking an Oncology Nurse Consultant (RN) for a 100% remote role spanning the contiguous U.S. You will lead clinical care coordination and utilization management within the Oncology Care Model, guiding members through diagnosis,...

Remote Care Manager (RN) - MUST LIVE IN TEXAS TX, United States Trending Job Description JOB DESCRIPTION We are searching for six TX licensed RNs to work telephonically with our Medicaid members across the state.

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...

Cambia Health seeks an Appeals Clinician I to evaluate member and provider appeals using nursing expertise and clinical judgment. This remote role supports multiple states and emphasizes medical policy, reimbursement guidelines, and compliance.

We are sharing a specialised remote consulting opportunity for experienced Registered Nurses with strong expertise in inpatient clinical care, nursing documentation, medical record review, clinical judgment, and healthcare quality assurance to...

Managed Medical Review Organization is seeking a licensed RN to join our team for remote, home-office work. This role emphasizes telephonic customer service, accurate documentation, and clinical review of medical records with no face-to-face...

Work From Home Nurse Practitioner (Remote Acute Visits, $210/hr)Join to apply for the Work From Home Nurse Practitioner (Remote Acute Visits, $210/hr) role at NPHireThis range is provided by NPHire. Your actual pay will be based on your skills and...

Redesigning heart health via virtual cardiac rehab for older adults.Mission-driven team of clinicians and engineers.Responsibilities:Review EMRs to determine eligibility and create orders.Conduct video intake assessments and treatment...

Comagine Health is seeking a Clinical Reviewer (RN) to evaluate medical necessity, quality and appropriateness of services under the WA L&I contract. This remote role supports case reviews across inpatient, outpatient, and complex imaging by...

Registered Nurse Navigator - Cancer Center Exams - 10 Hour Days 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...