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Yale University is seeking a Utilization Management RN for revenue integrity. This remote (Connecticut) role reviews documentation against payer policies and medical necessity criteria, prepares denial appeals, and educates providers to ensure...

Nascentia Health is seeking a Care Manager to provide care management for health plan members, create PCSP, coordinate services, and document care per plan standards. This is a remote-first role, Monday–Friday, 8:00 AM–4:30 PM. This...

Health & Human Services in North Carolina seeks a Nurse Consultant I (NS) to perform regulatory nursing home inspections, ensuring compliance with federal and state requirements and preparing deficiency reports. The role is home-based with regular...

Elevance Health is seeking a Nurse Case Manager I (RN) for a fully remote role, with required in-person training sessions. The position supports virtual collaboration across New York, with a Monday–Friday schedule and occasional late shifts.

Full-time Company Description WHO IS GUIDEHEALTH? Guidehealthis a data-powered, performance-driven healthcare company dedicated to operational excellence. Our goal is to make great healthcare affordable,...

Mary Washington Healthcare Incorporated is seeking a Level II Registered Nurse for a Virtual Registered Nurse (VRN) role. The VRN provides professional nursing care via two-way audio/visual technology, conducts virtual assessments, and...

About the opportunity: Vail Health has become the world's most advanced mountain healthcare system. Vail Health consists of an updated 520,000-square-foot, 56-bed hospital. This state-of-the-art facility provides exceptional care to all of...

CareHarmony is hiring a Licensed Practical Nurse (LPN) in Oklahoma City to join their team in delivering value-based care management. The role involves conducting health assessments, coordinating resources for chronic care, and educating patients.

JOB SUMMARY: The care management staff that KPPC employs are all state-licensed Registered Nurses or Licensed Social Workers. These professionals all have thorough knowledge of North Carolina patient resources and...

Overview AmTrust Financial Services, a fast growing commercial insurance company, has a need for a Telephonic Medical Case Manager, RN. PRIMARY PURPOSE:To provide comprehensive quality telephonic case management to...

Puget Sound Home Health and Hospice, a Pennant Group company, seeks a full-time Hospice Clinical Manager (RN) in Tacoma, WA. The role offers a $10,000 sign-on bonus, a salary range of $115,000–$135,000 DOE, and a flexible schedule including one...

Health & Human Services in North Carolina seeks a Nurse Consultant I (NS) to perform regulatory nursing home inspections, ensuring compliance with federal and state requirements and preparing deficiency reports. The role is home-based with regular...

Leveraging clinical expertise in a dynamic environment, the full-time Registered Nurse Utilization Management will assess, plan, and coordinate healthcare services for members while working remotely and requiring flexibility for evenings,...

Humana Inc. is seeking a Registered Nurse to join the Wisconsin Care Coaching team, coordinating member care, providing education, and helping members navigate their care with confidence. The role is remote with travel up to 40%; requires...

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts on the lives of millions of people for the better. Come build the health care...

Conduct telephonic nursing assessments and triage using protocols.Provide health education and referrals to diverse patient populations.Work Schedule:Full-time evenings with weekend shifts every two weeks.Virtual training for 2-4 weeks, 100%...

HCSC is seeking a remote QOC Nurse under the supervision of the QOC Manager to conduct review and investigation of quality of care issues. The role supports quality improvement activities in compliance with CMS, NCQA and other regulatory...

Job Summary and ResponsibilitiesAs our Educator in Critical Care Emergency, In accordance with our mission and core values of integrity, compassion, collaboration, and excellence, this position is established to serve as a consultant/resource...

Thank you for considering a career at Ensemble! Ensemble is a leading provider of technology-enabled revenue cycle management solutions for health systems, including hospitals and affiliated physician groups. They offer end-to-end...

Devoted Health is seeking a Clinical Guide for our Outpatient Utilization Management team. You will perform clinical reviews of outpatient authorization requests, applying evidence-based criteria and CMS requirements to ensure appropriate care...

Collaborative Practice Nurse (CPN) Blue Ridge Cancer Care is seeking an experienced and highly motivated Collaborative Practice Nurse (CPN) to support oncology patients across the continuum of care. The CPN serves as a clinical resource...

Cambia is hiring an Utilization Management Nurse to support our Clinical Services team. This remote role covers multiple states (OR, WA, ID, UT) with preference for Idaho/Utah residents and current employees. You will perform utilization...

At Curana Health, we're on a mission to radically improve the health, happiness, and dignity of older adults-and we're looking for passionate people to help us do it. As a national leader in value-based care, we offer senior living...

Hines & Associates, Inc. is seeking a full-time Case Manager to leverage clinical nursing experience to design care plans and advocate for patients. This fully remote role focuses on coordinating healthcare services while supporting...

Centurion Health is seeking a Full-Time CQI Specialist for our Regional Office team. This remote/traveling position requires residing in Northern Illinois with a commutable distance for site visits (2-4 days/week) and occasional travel to...