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Resp & Qualifications PURPOSE: The Clinical Appeals Nurse completes research, basic analysis, and evaluation of member and provider disputes regarding adverse and adverse coverage decisions. The...

Description: Job Summary: Provides remote consultative and supportive nursing care to Intensive Care Units (ICU) to multiple medical centers utilizing in room camera and EPIC technology from a remote, centralized hub.

Employment Type: Full timeShift: Day Shift Description: Position Summary and Highlights: Saint Alphonsus is hiring a Utilization Review...

Medical Case Manager - CT08GE We're determined to make a difference and are proud to be an insurance company that goes well beyond coverages and policies. Working here means having every opportunity to achieve your goals – and to help...

To apply you must live in the following States: MA, NH, RI, IA, CO, FL, SC, NC, RI, CT, VA, MD, UT Our Intake Manager is responsible for the day-to-day operations of the Intake department. This includes directly supervising...

Evenings, Weekend Only, Full-time & Part-time opportunities available (20hrs +) Hiring for evenings and weekends (*weekends and holidays are required) Incentives for Bilingual Spanish Telephone Triage RNs! Are you looking for an...

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...

Overview Advance Hospice Care. Lead Clinical Excellence. Inspire Compassionate Teams. We are seeking a dedicated Patient Care Manager to join our hospice team. Reporting directly to the Executive Director or...

If you are looking to make an impact on a meaningful scale, come join us as we embrace the Power of One! We strive to be an employer of choice and establish a reputation for being a talent rich organization where Associates can grow...

Nursing Manager / RN Required/ 5K Sign-OnJob LocationsUS-OH-COLUMBUSID2025-178144Line of BusinessResCare Community LivingPosition TypeFull-TimeOur Company ResCare...

Job Description Utilization Review RN RN at Providence Holy Cross Medical Center in Mission Hills, CA. This position is Part-time and will work 8-hour, Day shifts. Provide prospective, retrospective, and...

Become a Vital Part of Our Healthcare Team! The Utilization Management Appeals Nurse plays a crucial role in coordinating, documenting, and communicating essential medical services and benefit determinations. This position involves...

Valeris is a fully integrated life sciences commercialization partner that provides comprehensive solutions that span the entire healthcare value chain. Formed by the merger of PharmaCord and Mercalis, Valeris™ revolutionizes the path from life...

Job Summary This is a work on site position located in Danville, Pennsylvania. The Clinical Documentation Improvement Program (CDI) is designed to improve the physician's documentation in the patient's medical record, supporting the appropriate...

The Case Manager Hybrid I/II will provide case management services to patients and their families or caregivers. Assist with assessment, participate in planning and implementation of intervention and ensure follow-up and coordination of services.

Job Description Summary The Utilization Review Registered Nurse is responsible for reviewing medical services to ensure they meet evidence-based guidelines and member benefit plans. This includes...

We're building a world of health around every individual - shaping a more connected, convenient and compassionate health experience. At CVS Health®, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold...

Job Description Are you a registered nurse ready to take your career in an exciting new direction-one where your expertise truly makes a difference? Join Pennsylvania's premier Quality Improvement Organization and step into a...

About the Job Are you looking to make a difference in patients' lives with a company that values your expertise? Join us in our mission to deliver compassionate, high-quality healthcare where it matters most-at...

Job Type Full-time Description *This position requires 4-5 days/week onsite at either JHH or Saint Agnes* Summary/Position Objectives: This position is responsible for the planning,...

About Us Harris Health System is the public healthcare safety-net provider established in 1966 to serve the residents of Harris County, Texas. As an essential healthcare system, Harris Health champions better health for the entire...

RN Health Care Facility Surveyor - Remote (#1148) Company-issued and company-paid Amex card for travel All travel expenses paid directly by the company Airline...

Registered Nurse The VITAS Telecare RN is a member of the interdisciplinary team who is the pivotal person responsible for identifying the physical, psychological, social, and spiritual needs of those patients and families needing...

The Registered Nurse Care Manager provides case management services that are member-centric and include assessment, planning, facilitation, care coordination, evaluation and advocacy to all members across the healthcare continuum. The Care Manager...

Job Description JOB DESCRIPTION Opportunity for Texas licensed RN to join Molina as a Care Manager working with our Medicaid members in the Dallas, TX service delivery area. If hired, you will conduct face-to-face...