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Jobgether, on behalf of a partner organization, seeks an experienced Registered Nurse for a remote Utilization Management role. You will review cases, assess medical necessity, and support prior authorization decisions while collaborating with...

About This Role As a Clinical Grievances Nurse, you will review incoming retrospective cases to determine if appropriate care was given and ensure members' immediate needs are addressed. This role is ideal for those who can work PST hours...

The Utilization Management Registered Nurse at Humana interprets clinical data to support coordination, documentation and communication of medical services and benefit determinations for post-acute care. You will collaborate with physicians,...

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...

River Valley Child Development Services Inc seeks a Child Care Nurse Health Consultant to provide technical assistance and develop trainings on health, safety, and nutrition for childcare providers in WV. This exempt, full-time role offers remote...

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...

Summary Home Telehealth Care Coordinator (HTCC) Registered Nurse (RN) demonstrates leadership - experience - and creative approaches to management of complex patient care. The HTCC is responsible for coordination of health care for a...

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...

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...

A leading health care provider is seeking a Massachusetts Telehealth Nurse to assist patients in accessing care through phone consultations. Candidates must have a valid RN license in Massachusetts and 3+ years of clinical experience. The ideal...

Comagine Health is seeking an experienced Registered Nurse to serve as a Clinical Reviewer for the Washington Labor & Industries (L&I) contract. This remote role utilizes nursing expertise to evaluate medical necessity and quality of care,...

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...

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...

AccentCare, Inc. is seeking a Hospice Triage Registered Nurse for a remote, full-time position with nights and weekends coverage. Compensation ranges from $34.00 to $37.00 per hour based on experience, with eligible benefits for employees working...

A healthcare staffing company is seeking a Clinical Review Nurse for Prior Authorization Review. This remote role demands conducting reviews, collaborating with healthcare teams, and ensuring compliance. Candidates need an active RN license and...

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...

Peraton is seeking a Nurse Reviewer to join SafeGuard Services (SGS) and conduct medical record reviews, applying clinical judgment to claim payments. The role supports fraud investigations and referrals, with opportunities to develop cases for...

American Health Plans, a division of Franklin, Tennessee-based American Health Partners Inc. owns and operates Institutional Special Needs Plans (I-SNPs) for seniors who reside in long-term care facilities. In partnership with nursing home...

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

, remote Position: Remote Registered Nurse Company: Lehrer Family Chiropractic Location: Melville, New York, United States Contract Details: Part-time, remote Lehrer Family Chiropractic is seeking a highly...

Role Title: Registered Nurse Role Type: Contractor Location: United States, Remote We are engaging Registered Nurses to contribute their expertise to a dynamic project for a valued customer. In this role,...

Public Consulting Group in Oklahoma seeks a Client Success Partner for EDPlan Innovations – EDPlan Health. This role focuses on engaging client stakeholders, managing relationships, and delivering training on the EDPlan Health system for end...

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...

WellSky is seeking a registered nurse to conduct telephonic patient evaluations for multiple payer programs, working on Pacific Time hours. The role emphasizes remote care coordination, schedule management, and collaborative protocol development.

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,...