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Telehealth Triage Nurse - RN Purpose: Triages or manages symptom-based encounters with a patient over the phone or video, utilizing evidence-based triage protocols. Decreases unnecessary visits to physicians, APP's, and the emergency room...

Medical Review Nurse Analyst Our Medical Review Nurse Analyst is responsible for conducting clinical reviews of medical records to ensure compliance with regulatory and payer guidelines. This analyst ensures that providers are being...

Job Description: Participates in the development and ongoing implementation of QM Work Plan activities. Improve quality products and services, by using measurement and analysis to process, evaluate and make...

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 Navigator - Cancer Center Exams - 10 Hour Days Do you have a passion for the highest clinical quality and patient happiness? Would you like to use your expert clinical competencies with an organization known nationally...

Nurse, Concurrent Review Performs concurrent inpatient utilization review using InterQual criteria to determine if the request meets medical necessity criteria, including admission reviews, continued stay reviews, transitional care...

Clinical expertise meets analytical precision in a role that directly shapes how patient care is captured, understood, and valued across the health system. As a Clinical Documentation Specialist, you bring a seasoned nursing perspective into a...

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,...

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...

Job Summary: The Utilization Management Policy Initiatives Nurse RN II, under the purview the Utilization Management (UM) Department Leadership Team, is responsible for managing, reviewing, updating and creating...

About Wider Circle Wider Circle is a mission-driven healthcare organization on a mission to improve health outcomes for older adults and people with complex health needs. We do this by addressing the social and clinical barriers that get...

To support a growing team, the full-time remote Registered Nurse Bill Review will review facility and professional bills for accuracy, negotiate pre-surgical services, and provide expertise to claims staff while ensuring compliance with managed...

US Army Reserve – Psychological Health Program Nurse Case Manager (RN) The US Army Reserve Psychological Health Program (PHP) provides comprehensive behavioral health support to Reserve Soldiers and their families nationwide. As a Nurse...

Registered Nurse – Utilization Review (Remote) This is a fully remote Utilization Review RN role supporting multiple service lines and levels of care, including Inpatient, Extended Hospital Outpatient, and Observation (OBS).

Description Telephonic Nurse Case Manager (1099 Remote - NJ RN License Required) We are currently seeking an experienced Telephonic Nurse Case Manager (RN) to support workers'...

Fully Remote : Clinical Documentation Specialist Job Description Facilitate the improvement of clinical documentation by collaborating with physicians, nursing staff, and other patient caregivers.

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:...

Conduct comprehensive telehealth sleep evaluations and ongoing follow-up visits Diagnose and manage OSA and PAP therapy, insomnia (including BBT; CBT-I a plus), RLS/PLMD, EDS, and other sleep disorders Develop...

Remote Care Management Nurse (Future Opportunities) Work from home within Oregon, Washington, Idaho or Utah *Please be advised that this role is part of our candidate pool, which allows us to identify and attract...

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...

Case Manager The Case Manager utilizes a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual's benefit plan and/or health needs through communication and available...

Manager, Telephonic Nurse Case Management The Nurse Case Manager serves as the clinical resource within the Risk Management & Safety team, providing telephonic nurse case management to support injured employees through the workers'...

Workers' Compensation Telephonic Nurse Case Manager The Workers' Compensation Telephonic Nurse Case Manager is responsible for evaluating and expediting appropriate, cost-effective medical treatment of injured employees with the goal of...

Company Overview: Upward Health is an in-home, multidisciplinary medical group providing 24/7 whole-person care. Our clinical team treats physical, behavioral, and social health needs when and where a patient needs help. Everyone on our team from...

Job Description Nestled between Burbank and Pasadena, Adventist Health Glendale is one of the area's leading healthcare providers. We are comprised of a 515-bed hospital, two urgent cares, home care services, comprehensive...