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Centene is seeking a Clinical Appeals Coordinator to act as the statewide liaison for appeals, ensuring NCQA and state compliance. Ideal for clinicians with case management experience who are detail-oriented and skilled in communication.

Registered Nurse (RN) | Administration / ManagementLocation: Paramount, CAAgency: Titan Medical GroupPay: Competitive weekly pay (inquire for details)Shift...

Sentara Health is seeking an Integrated Case Manager, RN to support Eastern Shore region members, concentrating on behavioral health, waiver services, and complex care management. This remote role requires Virginia residency with travel 50%–75%...

Telephonic Insurance Case Manager (RN) | ARIZONA RESIDENTS ONLY Insight Global is seeking a Telephonic Insurance Case Manager (RN) to join a growing and well-established organization focused on helping injured employees navigate their...

Overview Our client is a trusted leader in healthcare services, dedicated to improving outcomes for patients and providers through innovative solutions and high-quality care. Join a team committed to making a meaningful difference in the...

UW Hospital and Clinics seeks a Nurse Case Manager (RN) to join our multidisciplinary team; remote work options available with flexible shifts. The role emphasizes utilization management, patient status assessment and collaboration with care teams...

A healthcare company seeks a Remote Utility Management Nurse to optimize insurance coding practices and enhance revenue management. This part-time role offers flexible hours and compensation ranging from $45 to $75 per hour, depending on...

Jobgether, on behalf of a partner organization, seeks an experienced Registered Nurse for a remote Utilization Management role. You will review cases, assess medical necessity, and support prior authorization decisions while collaborating with...

U.S. Department of Veterans Affairs is seeking a Remote Patient Monitoring Home Telehealth Case Manager. The role focuses on delivering knowledge-based care, patient education, self-management support, and ensuring patient satisfaction...

Our client, a mutual benefit corporation and health plan provider, seeks an accomplished Registered Nurse (Utilization Management) .Candidate must be authorized to work in USA without requiring sponsorshipLocation: 100% Remote for California...

Innovative Systems Group is seeking qualified healthcare professionals to conduct medical management and health education for customers on government programs. The role includes data gathering for regulatory reports and performing assessments,...

CVS Health is seeking a Clinical Case Manager to elevate patient care through nurse‑led, patient‑centered management. The role collaborates with members, providers, and community resources to address medical and social needs across the care...

The McLaren system includes 12 hospitals across the state, ambulatory surgery centers, imaging centers, a 730-member employed primary and specialty care physician network, commercial and Medicaid HMOs covering more than 242,000 Michigan lives,...

Case Management Utilization RNPrimary Location: Panorama City, California Facility Name: Panorama City Medical Offices 4 Employee Status: Regular Schedule: Part-time Scheduled Weekly Hours: 32 Shift: Day Salary: $68.95 - $84.38 / hour Job Number:...

UnitedHealth Group in El Paso, TX is seeking a Field RN Service Coordinator 1 – Case Manager to remotely support members with holistic assessments, care planning, and coordination across health and community services. The role emphasizes...

CareHarmony's Care Coordinators (LPN) (NLC) (LVN) work comprehensively with providers to deliver value-based care management initiatives for their patients. CareHarmony is seeking an experienced Licensed Practical Nurse – LPN Nurse (LPN)...

OPCO Skilled Management is seeking a Central Intake Nurse for a remote, full-time role. You will collect referral documentation from physicians, insurers, and providers to determine service appropriateness and coordinate patient care plans with...

About Clarity Pediatrics Clarity Pediatrics is reimagining pediatric chronic care, starting with ADHD. After successfully launching our virtual clinic for ADHD and anxiety, we are expanding our pediatric care platform to address other...

HCSC is seeking a registered nurse or licensed clinician to provide care coordination to members via telephonic and field-based care management. You will educate members on health care programs, discuss goals, and support clinical operations with...

RN Utilization Review Review patient medical records to assess the appropriateness and medical necessity of hospital admissions, continued stays, and services, while coordinating with providers and payers to ensure compliance with...

Utilization Management Registered Nurse (RN) - Remote Full-time WHO IS GUIDEHEALTH? Guidehealthis a data-powered, performance-driven healthcare company dedicated to operational excellence. Our goal is to...

Clinical Documentation Improvement Specialist-RN- Remote The Clinical Documentation Improvement (CDI) Specialist Registered Nurse (RN) assists with the identification of diagnoses, conditions, and procedures that are representative of the...

PIH Health in Los Angeles is seeking an RN Peer Review Analyst responsible for retrospective medical record reviews, data compilation to validate quality and accuracy of documentation, and auditing charts for admission/continued stay. You will...

Summary Home Telehealth Care Coordinator (HTCC) Registered Nurse (RN) demonstrates leadership - experience - and creative approaches to management of complex patient care. The HTCC is responsible for coordination of health care for a...

RN Status Review Specialist It's more than a career, it's a calling MO-REMOTE Worker Type: Regular Job Highlights: Use your nursing expertise in a strategic, non-bedside role. As an RN Status Review Specialist, you'll evaluate patient...