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Denials Case Manager, RN The Denials Case Manager, RN appeals all denials using InterQual criteria and medical necessity. Collaboratively works with all members of the revenue cycle team and all types of payers to resolve denials,...

Clinical Review Nurse - Prior Authorization Various, NV Clinical Review Nurse - Prior Authorization Various, NV All On-site Location: Fully Remote – Prefer Candidates reside in NV, but can reside elsewhere if they...

Utilization Management RN IL Regional Office - Springfield, Illinois Overview Position Type: Full-Time Job Shift: Day Education Level: Bachelor's Degree Category: Nursing Professional & Support Description...

Grow HealthyIf you are as passionate about helping those in need as you are about growing your career, consider AltaMed. At AltaMed, your passion for helping others isn't just welcomed - it's nurtured, celebrated, and promoted, allowing you to...

Overview As a patient-focused organization, University of Utah Health exists to enhance the health and well-being of people through patient care, research and education. Success in this mission requires a culture of...

Registered Nurse (RN) – Utilization Management (24/7 Operations) Step away from bedside care and make a system-wide impact. Join our Utilization Management team and help ensure members receive the right care at the right time.

Utilization Management Nurse RIHS Austin Regional Office - Austin, TX 78727 Overview Position Type Full Time Description Primary Responsibilities The Utilization Management Nurse will determine the...

Care Manager The Care Manager is responsible for providing care management to a group of health plan members, creating the Person-Centered Service Plan (PCSP), coordinating services, and documenting care in accordance with health plan...

Working remotely, the full-time RN Utilization Management will review and document member case histories and prior authorization requests, utilizing clinical judgment to determine coverage eligibility while ensuring compliance with policies and...

Clinical Case Manager Opportunity Are you ready to bring your expert clinical skills to a world-class facility recognized as one of the top ten in the United States? Do you have a passion for the highest quality and patient happiness?

Position TitleRegistered Nurse, Case ManagerLocationMontebello, CA 90640DescriptionGrow HealthyIf you are as passionate about helping those in need as you are about growing your career, consider AltaMed. At AltaMed, your passion for helping others...

Job Opportunity Seeking a compassionate and driven Registered Nurse (RN) Care Manager to join our team in a role designed for nurses who are ready to expand their impact beyond the traditional clinical setting. This position offers the...

RN - Case Manager Case managers work to facilitate patient care by assessing patient needs, evaluating treatment options, creating treatment plans, coordinating care, and gauging progress. The overall goal for case managers is to improve...

Yourcommission is seeking qualified candidates for nursing roles in Beverly Hills, California. Applicants must have a valid RN license and a Bachelor of Science in Nursing. Experience in acute care nursing and case management is preferred.The role...

Nurse Reviewer 1 Nurse Reviewer 1 Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes...

Kindred Hospital Los Angeles Kindred Hospital Los Angeles helps patients return to the lives they love. At our hospital, our physician-led care teams provide critically ill patients with the specialized acute care and rehabilitation they...

Professional Nursing Care 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...

Capital Health is the region's leader in providing progressive, quality patient care with significant investments in our exceptional physicians, nurses and staff, as well as advanced technology. Capital Health is a dynamic health care resource...

Job Title : Registered Nurse (RN) Disease ManagerJob Overview :The Registered Nurse (RN) Disease Manager is responsible for coordinating care and managing the health outcomes of patients with chronic or complex health conditions. This role...

Company : Highmark Inc. Job Description : JOB SUMMARY This job has primary ownership and oversight over a specified panel of members that range in health status/severity...

The University of Southern California seeks an RN Case Manager to provide care coordination services, ensuring quality outcomes through effective patient management in Los Angeles. The role involves working closely with an interdisciplinary team...

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...

Grow Healthy If you are as passionate about helping those in need as you are about growing your career, consider AltaMed. At AltaMed, your passion for helping others isn't just welcomed - it's nurtured, celebrated, and promoted,...

Position Summary Monitors the admissions, continued stay, and discharge of patients following pre-established criteria. Assures that patients meet MCG criteria from admission to discharge including appropriateness of level of care. Conducts...

Payment Integrity Nurse – Medicare Advantage We are currently hiring for a Payment Integrity Nurse – Medicare Advantage to join BlueCross BlueShield of South Carolina. In this role as a Payment Integrity Nurse, you will...