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When you join the growing BILH team, you're not just taking a job, you're making a difference in people's lives. This position is remote. Candidates must be local to New England States for...

Job Title Provides support for healthcare services clinical auditing activities. Job Summary Performs audits for clinical functional areas in alignment with regulatory requirements - ensuring quality compliance and desired...

Registered Nurse Sanford Health, the largest rural health system in the United States, is dedicated to transforming the health care experience and providing access to world-class health care in America's heartland. The Center for...

Job Title 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,...

RN Utilization Mgmt Full-Time Day POSITION SUMMARY The RN Utilization Management (RN UM) functions as a support liaisons for a variety of UM functions which may include: the e-TAR process, denials management,...

Center Nurse Executive The Center Nurse Executive (CNE) will oversee the day-to-day operations associated with nursing practice, direct patient care activities, clinical education, and the continuous improvement (Quality Assurance) of...

Care Coordinator 2 (Field Care Manager 2) Humana Healthy Horizons in Indiana is seeking a Care Coordinator 2 (Field Care Manager 2) who assesses and evaluates member's needs and requirements to achieve and/or maintain optimal wellness...

Nurse Consultant II (NS) This is a home-based position in the Central/Western Region and individuals should reside in Wake, Guilford, Alamance, Mecklenburg, Forsyth, Durham, Chatham, Randolph, Johnston, Harnett, Lee, Moore, Franklin,...

Adventist Health in Los Angeles seeks a qualified RN Nursing Supervisor. Located in Boyle Heights, you will oversee nursing operations, ensure staff quality, and manage patient care across departments. The role requires strong nursing supervision...

The Clinical Documentation Specialist is responsible for the evaluation of physician documentation utilizing their clinical expertise to ensure the patients' severity of illness is accurately portrayed in the medical record for specificity of...

Summary Performs medical reviews using clinical/medical information provided by physicians/providers and established criteria/protocol sets or clinical guidelines. Documents decisions using indicated protocol sets or...

Prior Authorization RN - Contract Role Location Requirement: Candidate must reside in NJ, PA, NY, CT, or MD Work Model: WFH, but must be able...

Medical Review Specialist Scope: The Medical Review Specialist is a Registered Nurse who conducts the Utilization Review process by obtaining medical information and confirming the medical necessity of hospital admissions and/or...

Requisition number: 2367514 Job category: Nursing For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the...

DescriptionJOB TITLE: Nursing Program Coordinator– Nursing ProgramSTATUS: Full Time/Part TimeTYPE: On CampusREPORTS TO: Director of NursingPurposeThe Nursing Program Coordinator is responsible for providing administrative support to the Director...

Quick Hiring for "Remote Clinical Review Nurses" Job Description: Review approximately 20 cases a day for medical necessity. Advocate for and protect members from unnecessary hospital...

Utilization Management Admissions Liaison RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: Full Time Requisition ID: 13180 Salary Range:...

Overview Performs inpatient chart review to determine appropriate DRG assignment and assures appropriate documentation in the chart to support clinical care provided, including severity of illness and risk of mortality which...

The Registered Nurse (RN) Case Manager provides care coordination which emphasizes positive partnerships with nursing, physicians and other key disciplines in order to pace...

We are seeking to hire a full-time Registered Nurse to join our team! We are a skilled nursing facility looking for dynamic associates to join our clinical team and provide our residents with a best-in-class care experience! Whether you are just...

Job Summary and ResponsibilitiesThe Assistant Nurse Manager (ANM) provides clinical and operational leadership support for assigned perioperative and procedural patient care areas, including Pre-Op / ACC and GI / Endoscopy services. The role is...

Field Nurse Case Manager Paradigm is an accountable specialty care management organization focused on improving the lives of people with complex injuries and diagnoses. The company has been a pioneer in value-based care since 1991 and has...

Clinical Policy Nurse RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: Full Time Salary Range: $88,854.00 (Min.) - $142,166.00 (Max.) Established in 1997, L.A. Care Health...

Description The Quality Management Nurse is responsible for conducting comprehensive facility site reviews (FSRs) to ensure compliance with healthcare standards and regulations. This role involves evaluation clinical practices, identifying areas...

Your job is more than a job RN Care Manager - PRN - Remote You overthink every care option and scenario because, as a Care Manager, you're the hub of your patient's case management and care plan. You assure quality through...