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JOB DESCRIPTION Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and...

CorVel Corporation seeks a Nurse Trainer to develop and revise training materials for nursing staff in a clinical setting. You will organize curricula, assess effectiveness, and ensure new hires complete training and QA reviews. The role is...

Cambia Health Solutions is seeking a dedicated Utilization Management Nurse to perform prospective, concurrent, and retrospective reviews, ensuring medical necessity and cost-effective care. You will collaborate with interdisciplinary teams,...

CVS Health is seeking a Utilization Management Nurse Consultant (Medical Review) to ensure members receive timely, medically necessary care through thoughtful clinical review and collaboration with providers. This fully remote role leverages your...

HonorHealth is seeking an experienced Utilization Review RN Specialist for a remote-capable role serving the greater Phoenix area. The position focuses on reviewing medical necessity and coordinating reviews for diverse payers, ensuring...

A healthcare services provider is seeking a Remote Utilization Review Nurse to coordinate clinical resources, ensuring compliance with healthcare standards. Responsibilities include processing authorizations, reviewing documentation, and...

Cleveland Clinic Health System is seeking an experienced Utilization Management RN Reviewer to work remotely with a focus on admission, concurrent and retrospective reviews. The role supports payer communications, data collection, and clinical...

Essentia Health Moose Lake Clinic is seeking a licensed registered nurse for the Family Practice team. The role emphasizes primary care, triage, and coordination of care for individuals, families, and communities in outpatient settings.

Nurse Case ManagerPosition Type: Full-Time Contract RoleLocation: Work from homeWork Type: Remote Est. Pay Range: $35.00/hour – $38.46/Hour on W2 (USD) (all inclusive)Schedule: Mon-Fri 8am-5pm ESTRegistered Nurse with active state license in...

Actalent is seeking a Case Management Nurse in Milwaukee, WI to coordinate comprehensive patient care and advocate for access to services across the continuum of care. The role blends direct client contact with care coordination, education,...

Utilization Management Policy Initiatives Nurse RN II The Utilization Management Policy Initiatives Nurse RN II, under the purview of the Utilization Management (UM) Department Leadership Team, is responsible for managing, reviewing,...

Family Service of Rhode Island (FSRI) seeks a per diem School Nurse to join our multidisciplinary team in Exeter, RI. The nurse provides healthcare services to students and staff, manages health needs, responds to emergencies, and supports...

Alignment Health is seeking an inpatient review nurse to join the remote utilization management team. The role focuses on reviewing inpatients with complex medical needs, coordinating with PCPs, facilities, and community resources to ensure...

TEEMA is seeking an RN with 3+ years of clinical experience for a remote role in the United States. The position emphasizes medical record review, quality assurance, and collaboration with medical leadership. The role requires strong...

Alignment Health is seeking an inpatient review nurse to join our remote utilization management team. The nurse will collaborate with the patient's PCP, facility case manager, discharge planner, and contracted providers to ensure appropriate,...

Clinical Documentation Integrity Specialist IIThe Clinical Documentation Integrity Specialist II (CDI) is responsible for utilizing independent clinical judgement in facilitating the integrity, overall quality, accuracy, and completeness of...

Alignment Health is seeking an inpatient review nurse to join the remote utilization management team. You will assist patients through the continuum of care in collaboration with the patient's primary care physician, facility case manager,...

Trillium Health Resources is seeking a Population Health Nurse to provide clinical care management and population health support for assigned members, focusing on prevention, wellness, and outcomes. The role uses nursing judgment as an RN to...

Saratoga Medical Center in Falls Church, Virginia is seeking a Clinical Nurse – Case Manager to coordinate patient care across care settings, manage complex cases, and facilitate transitions. This full-time role offers telework options and a...

HCSC is seeking a remote QOC Nurse under the supervision of the QOC Manager to conduct review and investigation of quality of care issues. The role supports quality improvement activities in compliance with CMS, NCQA and other regulatory...

nirvanaHealth is seeking a part-time Utilization Management (UM) Nurse to join our remote team. The UM Nurse will perform prospective, concurrent, and retrospective medical necessity reviews, determine level of care, and participate in initial...

A reputable healthcare staffing firm in Oregon is seeking a care manager specializing in phone communication with patients across all ages. The role involves coordinating care services, educating patients on their health conditions, and conducting...

Ochsner Health, a leading not-for-profit healthcare provider in the Gulf South, seeks an experienced RN for a remote case management role. You will coordinate care by liaising with patients, caregivers, multidisciplinary teams, and payers to...

A healthcare service provider is seeking an Appeals and Grievances Clinical Specialist to manage member complaints and clinical case resolutions. This is a 100% remote role requiring an RN, LPN, or Dental Hygienist license. Responsibilities...

Praxis Health is hiring a Nurse Care Manager for a remote role serving residents of Oregon, Washington, and Idaho. The position coordinates care, conducts follow-ups, and promotes evidence-based practices to improve outcomes and patient...