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Optum is seeking an Utilization Management Nurse to review medical records, extract key case details, and craft defensible appeal letters in line with process instructions and guidelines. The role requires an RN with an associate degree, 3+...

A healthcare solutions provider is looking for a qualified RN to perform medical reviews and coordinate care for members. This role involves assessing service needs, engaging in patient education, and ensuring compliance with healthcare...

Vaya Health seeks a Physical Health Registered Nurse to perform clinical reviews for authorization requests and medical necessity. You will reference standardized criteria and coordinate with physician peers when needed. This role is part of a...

Namely is seeking California Based Nurse Care Managers for remote work to support members through their healthcare journey, ensuring needs are met with leading interventions. The position requires a Bachelor of Science in Nursing, 5+ years...

Area Quality Specialist Registered Nurse Find your purpose giving patient care teams the knowledge and tools they need to better care for patients as an Area Quality Specialist Registered Nurse! This is a rare opening on a...

A healthcare recruitment firm is seeking a Lead Healthcare Recruiter (Utilization Management RN) for a remote 6-month contract. The ideal candidate will have an active RN license and experience with health plan operations. Responsibilities include...

Overview TEEMA is partnering with a leading organization supporting a large-scale federal healthcare program to identify a Clinical Quality Reviewer. This role focuses on reviewing clinical cases, identifying potential quality or safety...

UnitedHealthcare is seeking an RN Care Manager to work remotely within Mecklenburg County, NC. In this role you will assess and plan individualized care, coordinate referrals, and advocate for members to ensure access to appropriate services.

Broadway Ventures, a veteran-owned SDVOSB headquartered in Mississippi, seeks an experienced Registered Nurse to perform medical review of complex claims, pre-authorization requests, appeals, and fraud referrals. You will apply clinical expertise...

A leading healthcare company is seeking an experienced Telephonic Nurse Case Manager to manage medical claims and facilitate care for injured workers. The ideal candidate will have at least a year of experience in Florida Workers' Compensation,...

Inland Empire Health Plan (IEHP) seeks a Quality Program Nurse to implement and monitor quality management policies under the DHCS framework. Responsibilities include site reviews, medical record surveys, CAP oversight, and HEDIS data abstraction.

Overview: Mountain Ridge is HIRING MDS Coordinator Flexible Schedule - Full time OR Part time This is not a remote role, onsite is required Offering $10,000 Bonus We are dedicated to improving the lives we touch through the delivery of...

RN CASE MANAGER – CARE MANAGEMENT DEPARTMENT - University of New Mexico Hospital – Albuquerque *Inpatient *Outpatient *Utilization Management *SRMC Care Management *Full Time *Part Time Receive 17% Weekday Nights, 26% Weekend Nights and 15%...

We are so glad you are interested in joining Sutter Health! Organization: SHSO-Population Health Services-Utah Position Overview: The Virtual Mental Health Intake RN is a Registered Nurse who provides competent and...

Utilization Management - Clinical Nurse - Work from Home! Utilization Management - Clinical Nurse - Work from Home! Get AI-powered advice on this job and more exclusive features.Direct message the job poster from BroadPathGlobal Talent Attraction...

A healthcare provider is seeking a Utilization Review Nurse to coordinate resources and ensure efficient delivery of home health care. This role involves monitoring patient admissions and ongoing care while ensuring adherence to guidelines. The...

TurningPoint Healthcare Solutions is a rapidly growing and innovative healthcare company that supports several large national health plans to improve the quality and affordability of healthcare patients receive. We are looking for motivated...

Overview JOB PURPOSE: This position is responsible for conducting medical management and health education programs for customers on government health care programs. Accountabilities include gathering, analyzing and providing data for...

Centene Corporation is seeking a remote Mississippi-based Registered Nurse to develop and manage complex care plans for members, coordinating with providers and families to ensure timely, person-centered care. The role emphasizes ongoing...

Brighton Health Plan Solutions seeks an experienced Utilization Management Nurse (LPN) to perform medical necessity and benefit reviews remotely. You will work within UM processes, coordinate with partners, and ensure timely, compliant...

Central Health seeks a Nurse Case Manager to identify, screen, track and coordinate care for members with multiple co-morbidities and psychosocial needs. This role may work remotely with occasional travel to Austin, TX, under the Manager of Case...

A health care provider organization is seeking a Case Management Nurse to coordinate care for members. This role requires a Nursing Diploma and direct clinical experience, along with the current Michigan RN license. Responsibilities include...

EK Health Services is hiring a Full-Time Telephonic Nurse Case Manager (RN) for the Case Management Team. The role involves assessing, planning, coordinating and evaluating service options to help injured workers obtain timely, cost-effective care...

Private Health Management is seeking a Nurse Advisor to guide clients through complex healthcare journeys, educating and advocating for high‑quality care. You'll coordinate care, support families, and collaborate with clinical and operations...

Guidehealth is seeking a remote Care Manager who can blend clinical nursing expertise with holistic patient care. You will guide patients and families through complex health journeys, coordinate care across providers, and empower members with...