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Centene Corporation seeks an experienced RN to analyze prior authorization requests from a remote location within the United States. The role evaluates medical necessity and appropriate level of care in line with national standards and contract...

What You'll Do As an Enrollment Nurse, your primary responsibility is enrolling patients in a chronic care management program. You'll call eligible patients, educate them about the program, answer questions, and assist interested patients...

8 Hours POSITION SUMMARY The Clinical Staff Nurse is a skilled and experienced professional Registered Nurse (RN) responsible for excellence in the clinical practice of nursing and the management of patient care.

Concierge Home Care | Remote Opportunity | Growth Opportunities | Increased Earning Potential At Concierge Home Care, we are growing and looking for an experienced Utilization Review Specialist (RN) to join our remote home health...

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...

CVS Health is hiring an RN Utilization Management Nurse Consultant (Medicare - Joint Procedures) for remote, full-time work. You will review Medicare precertification data, apply criteria, and coordinate care plans to ensure appropriate treatment...

Opus Medical is seeking a Nurse Liaison to coordinate care and communicate crucial medical information in the United States, specifically in Pensacola, Florida. This remote role involves responsibilities like managing case plans, building...

Registered Nurse Locations: Los Angeles, California Job Category: Registered Nurse Position Type: Full-Time Shift: Evenings Job Description Join a team that's shaping the...

Maine Community Health Options is seeking a Clinical Specialist who provides clinical decision-making support and coordinates community resources to support medical management. This role analyzes documentation for medical necessity, collaborates...

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,...

Sentara Health Plans seeks an RN Clinician to perform utilization management and claim reviews across inpatient and outpatient settings. The role supports pre/post payment reviews and authorization assessments, ensuring compliance with policy and...

Explore opportunities with Amedisys, part of the Optum family of businesses. We provide home health, hospice and community-based services that help people receive quality care where they feel most comfortable: at home. Rooted in personalized care,...

About the Role Mercor is hiring experienced Nurse Practitioners to help evaluate and improve cutting-edge AI systems. In this role, you'll evaluate AI-generated clinical content and workflows, leveraging your real-world expertise in...

Job Title: Utilization Management Registered Nurse (UM RN) – SNF / MLTC Location: Remote (Must reside in NY, NJ, or CT) Schedule: Monday – Friday, 9:00 AM – 5:00 PM Position Type: ...

Remote Patient Monitoring (RPM) Nurse – Remote Join Our Growing Clinical Team! We are seeking compassionate, detail-oriented Registered Nurses (RNs) or Licensed Practical Nurses (LPNs) to join our Remote Patient Monitoring...

CVS Health is seeking a Nurse Consultant for Utilization Management in a 100% remote role. You will apply clinical judgment and evidence-based criteria to review inpatient and outpatient services, collaborate with providers to authorize care, and...

argenx SE is seeking a Nurse Case Manager to serve as the primary contact for patients and caregivers across the Western time zone. You will educate patients with gMG, review insurance coverage, and coordinate therapies to support adherence and...

Job OverviewPay Range: $46.76hr - $51.76hrRequirement/Must Have5+ years Clinical nursing experience.2+ years Care Management.Bachelor's Degree in Nursing.In lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required...

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...

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,...

Iconma Portal is seeking a Registered Nurse-Review Analyst for a remote position with a Health Insurance client. You will conduct prospective, concurrent, and retrospective reviews across inpatient, outpatient, ambulatory, and ancillary services...

Health Care Service Corporation is hiring a Nurse Liaison I for Utilization Management & Quality Review. This remote nationwide role supports clinical review activities, benefit determinations and medical necessity assessments, ensuring compliant,...

CVS Health is seeking a Nurse Consultant for Utilization Management in a 100% remote capacity. The role reviews inpatient and outpatient services using evidence-based criteria, authorizes care with providers, and escalates cases as needed.

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...

Centene Management Company LLC is seeking a Licensed Practical Nurse to analyze prior authorization requests and determine medical necessity in New York. You will work with healthcare providers and the authorization team to ensure timely,...