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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...

Utilization Review Specialist (RN) – Work From Home (Florida-Based Candidates Only)Concierge Home Care | Work From Home Opportunity – Must Reside in Florida At Concierge Home Care, we are growing and looking for an experienced...

Elevance Health is seeking an experienced nurse to review complex cases for medical necessity, applying clinical guidelines and nursing judgment. The role involves collaboration with physicians, case managers, and Medical Directors to optimize...

Position: Remote Nurse Consultant Company Overview: Absolute Elder Care is a leading provider of in-home care services for seniors. Our mission is to provide compassionate, personalized care to help seniors maintain their...

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...

Delivering high-quality nursing care from a remote setting, the full-time Remote Care Nurse II will conduct patient assessments, develop care plans, and coordinate with multidisciplinary teams to optimize health outcomes using telehealth...

Program Integrity Clinical Compliance AuditorOptum Insight is improving the flow of health data and information to create a more connected system. We remove friction and drive alignment between care providers and payers, and ultimately consumers.

Immediate need for a talented Utilization Management RN - Prior Authorization. This is a 12+ Months Contract opportunity with long-term potential and is located in US (Remote). Please review the...

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...

IQVIA LLC is seeking a Flex Nurse Educator to support patient education remotely with in-field coverage as needed. The role emphasizes non-clinical, educational interactions and adherence improvement, while maintaining privacy and high educational...

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...

Position Title: Remote Telephonic RN Case Manager Mandatory Requirement: Must hold an Active Compact RN License and/or an Active California (CA) RN License to be considered. Pay Rate: $48.00 – $50.00 per hour...

Clinical Nurse, Medical Management/Utilization Management Saratoga Medical is hiring for a Clinical Nurse, Medical Management/Utilization Management in Falls Church, Virginia. Package includes competitive rate, paid time off and benefit...

Job Title: Nurse, Clinical Medical Review Location: Columbia, MD (Primarily remote, but hybrid) Duration: 6 Months Contract PURPOSE: We are seeking a qualified RN or LPN with experience supporting HEDIS reporting and abstraction processes in a...

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 make...

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,...

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...

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...

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.

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...

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,...

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...

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...

Managed Medical Review Organization is seeking a skilled registered nurse for a remote, home-office role. The position emphasizes telephonic/customer service, accurate documentation, and clinical review duties without face-to-face patient contact.

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...