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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...

Compliance Nurse Trillium Health Resources is a Tailored Plan and Managed Care Organization (MCO) serving 46 counties across North Carolina. We manage services for individuals with serious mental health needs, substance use disorders,...

Sagility is hiring an RN Utilization Management Reviewer for a fully remote, home-based role in the United States. You will perform day-to-day clinical and service authorization reviews for medical necessity and ensure compliance with CMS...

Yoh is seeking a Utilization Management Nurse Coordinator (RN or LVN) for a 6+ month remote contract with a managed care client based in Northern California. Training occurs onsite in Fairfield or Redding for three weeks, then transitions to fully...

Children's Mercy Job Opportunity Do you envision finding a meaningful role with an inclusive and compassionate team? At Children's Mercy, we believe in making a difference in the lives of all children and shining a light of hope to the...

CVS Health is seeking an RN Nurse Consultant for a remote role focused on utilization management and benefit coordination. The position emphasizes evidence-based decision making and collaboration with providers to ensure appropriate patient care.

State of Washington's Nursing Consultant role conducts investigations and inspections for Region 1C to ensure long-term care providers meet WAC and RCW requirements. This highly independent position manages a worklist, travels to facilities, and...

About the Role: Our client, a leading telehealth platform, is expanding rapidly and looking for a dedicated Nurse Practitioner to join their virtual care team. You will provide exceptional primary care services to a diverse patient...

Optum is seeking a Clinical Consultant RN, Medical Policy Writer for a remote role within the United States. You will lead clinical oversight of product medical policies, develop utilization guidelines, and support COE network criteria. The...

Spectraforce Technologies, Inc. is seeking a Clinical Review Nurse - Prior Authorization for a 12-month assignment. The role is remote (PST/CST) with scheduling across multiple shifts, supporting national guidelines and contractual requirements.

Clinical Facility Site Review Support Provides support for clinical facility site reviews. Under the supervision of leadership, uses clinical judgement within appropriate scope to independently conduct reviews and other monitoring...

Qlarant, a nonprofit organization, seeks a Nurse Specialist II to perform medical record and claims review for Medicare, Medicaid, and other data. This remote role in the United States involves ensuring adherence to guidelines while assessing for...

Job ID: 33380 *Description*There's nothing more exciting and rewarding than being able to make a significant, positive difference in someone's life. At UCLA Health, you'll experience this joy every day while also enjoying the positive,...

Remote Registered Nurse – Clinical Review Fully Remote | $48–$65/hr | Monday–Friday, 9:00 AM–6:00 PM ET Medix is supporting a healthcare technology organization that is adding...

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data...

Utilization Review Nurse Join our team at Cobalt Benefits Group and start an exciting new career in employee benefits solutions. As a Utilization Review Nurse, you'll play an important role in helping us offer customized, self-funded...

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...

JOB DESCRIPTION AND POSITION REQUIREMENTS If you reside in one of the states listed in the above Notice to Out of State Applicants, please complete our SAFE‑T TeleSANE interest form. We accept qualified applicants from all states. Shape the next...

Remote Registered Nurse – Clinical Review Fully Remote | $48–$65/hr | Monday–Friday, 9:00 AM–6:00 PM ET Medix is supporting a healthcare technology organization that is adding...

Float Health is seeking an Intake Specialist to manage new patient referrals and coordinate start-of-care visits. This externally facing role requires quick action, clear communication, and meticulous attention to detail to ensure timely,...

Nurse Consultant/ Regional Director Of Clinical Operations Relocation to Southern New Mexico is required. The Nurse Consultant/ Regional Director of Clinical Operations position is comprised of two essential objectives; to partner...

Actalent is seeking an LVN Nurse Consultant for a fully remote telephonic nursing position. You will contact patients or caregivers to ensure adherence to prescribed therapies and address issues they may encounter, including nursing home...

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...

Hone is a virtual medical clinic for men's/women's health, hormones, weight loss, and longevity.We are remote-first and fast-growing, focused on candid communication and joy.The Role:You will manage patient-doctor communications and clinical...

Trinity Health is seeking a Night Shift RN Utilization Review in Grand Rapids, MI, offering full-time work with remote options. You will review assigned cases against criteria and payor guidelines to ensure proper reimbursement and medical...