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Guardian Life Insurance Company seeks an experienced RN Clinical Consultant to evaluate short- and long-term disability claims, analyze medical information, assess functional capacity, and support claim decisions. You will collaborate with...

Customer Success Nurse Consultant The Customer Success Nurse Consultant (CSNC) is responsible for driving post-implementation success for ICU Medical's infusion technologies through clinical expertise, data-driven consulting, and...

Centene is seeking a Nursing professional to perform concurrent reviews from a home-based setting, ensuring appropriate care levels and discharge planning. Requires an Iowa license (or compact) and nursing degree with 2–4 years of related...

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...

Job Summary: As the leader of the health care team, provides professional nursing care, utilizing the nursing process in accordance with established standards of care, policies, and procedures. Demonstrates performance...

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...

The State of Washington's Department of Social and Health Services seeks a Nursing Consultant Institutional in Arlington. You will conduct licensing inspections and investigations, evaluate care quality, and ensure compliance with state...

HonorHealth is seeking an Utilization Review RN Specialist to review and monitor the utilization of health care services, ensuring medical necessity and appropriate levels of care. You will coordinate reviews for Medicare, AHCCCS, self-pay, and...

Cleveland Clinic is seeking an Utilization Management RN Reviewer to support remote operations from home. The role covers admission and concurrent reviews, and ensures medical necessity criteria are applied to hospital stays and discharges.

Bring clinical insight, nursing expertise, and data-driven precision to a Hybrid/Remote Clinical Documentation Improvement Nurse Specialist career that combines meaningful patient impact, supportive leadership, modern healthcare technology,...

Title: QIC Part A Nurse Consultant Location: Remote Duration: 6 months Shift time: Hours; 8:30 am - 5:00 pm EST (Monday - Friday) Pay rate: 30.00/hr Job Description Essential Duties and...

Relocation to Southern New Mexico is required. The Nurse Consultant/ Regional Director of Clinical Operations position is comprised of two essential objectives; to partner with facilities as the primary clinical resource in...

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...

hackajob is collaborating with Oracle to connect them with exceptional professionals for this role. About the team Responsible for driving the client through the design of clinical and business processes, solution and technology workflow, and...

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...

Sedgwick is hiring for a Clinical Consultation Triage Nurse in a remote, full-time role. You will triage calls, assess needs, and provide care guidance to determine the appropriate level of care, while supporting return-to-work goals. The...

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,...

WNS, part of Capgemini, seeks a remote Utilization Review Nurse to perform medical necessity reviews and collaborate with providers to ensure compliant patient care. The role emphasizes adherence to HIPAA, state and federal regulations, and a...

Clinical Appeals Nurse We are seeking an experienced Clinical Appeals Nurse to support the appeal and grievance processes by analyzing and responding to adverse coverage decisions. This role involves clinical judgment, regulatory...

Description We are hiring for a part- time School Nurse Consultant, come join our team! This is a non-benefited position that works on an as needed basis. See CESA 6 Values Here See details and apply on our website.

Concurrent Review Nurse (RN) 100% Remote | Monday–Friday, 8:00 AM–5:00 PM CST Occasional Weekend & Holiday On-Call Coverage Are you an experienced inpatient Registered Nurse looking to transition into a remote role where...

Comagine Health seeks a Consultant to support our Health System Improvement team, with a focus on Long Term Care Facilities. This on-call role provides expert guidance across clinical, operational, public health, and quality improvement domains to...

Womble Bond Dickinson (US) LLP seeks a Nurse Consultant to join our team. The Nurse Consultant provides high-level medical analysis and insight in support of legal matters, reviewing, interpreting, and synthesizing complex records into clear,...

Cunningham Children0s Home in Urbana, IL seeks a Nurse Case Manager to support residential programs with medical case management, screening, education, counseling, and medication management, while networking with community health providers. The...

Supports the values of service excellence, teamwork, and integrity while managing patient care.Acts as a liaison among patients, caregivers, multidisciplinary teams, and payers.Qualifications:Requires a current RN license, nursing diploma or...