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Job Summary The RN Clinical Appeals Nurse provides support for internal appeals clinical processes - ensuring that appeals requests are reevaluated in alignment with applicable federal and state regulatory requirements, Molina policies...

A healthcare provider is seeking a Utilization Management Clinical Manager for analyzing medical service requests. The ideal candidate will possess an RN license and extensive experience in prior authorization in managed care. Responsibilities...

Registered Nurse Case Review Specialist Position is Remote/Nationwide Job Summary STGi is currently seeking a Registered Nurse Case Review Specialist. The position is remote and open to candidates nationwide. Provides direct...

A leading healthcare provider is seeking a dedicated pediatric nurse to provide and supervise in-home care for children with complex conditions. Candidates must have at least three years of acute care experience and be skilled in administering...

A telehealth practice is seeking a Virtual Registered Nurse for a 6-month contracted position to provide high-quality patient care through EMR communications and triage. Candidates should have a BSN and an active nursing license, along with...

A leading healthcare organization is seeking a Care Manager RN for a remote role primarily serving the state of Washington. This per diem position involves crucial utilization management activities, ensuring compliance with payer requirements and...

JOIN TEAM TRILOGY:At Trilogy, you'll experience a caring, supportive community that values each team member. We prioritize meaningful relationships, genuine teamwork, and continuous growth. With the stability of...

A healthcare organization is seeking a Nurse Home Visitor in Stratford, Connecticut. This role involves providing home visiting services to new parents, assessing family needs across various domains, and connecting them with community resources.

A leading healthcare company is seeking a Prior Authorization RN to support its Wisconsin Medicaid Market team. This remote position involves reviewing prior authorization requests to ensure compliance with medical guidelines. Candidates must be...

A healthcare management firm is seeking a detail-oriented Utilization Management Reviewer for a fully remote position. The role includes reviewing care based on evidence-based guidelines, ensuring quality and compliance while upholding medical...

Job Description: NonCNA/NonSTNA Lincoln Village Columbus, OH PRN 7am or 7pm start Lincoln Village, located in Columbus, OH, is an...

Quality Assurance Position Pay: $34/hr Contract Details + Contract Duration: 520-hour contract-to-hire, long term opportunity Compensation: listed below, fixed rates (no opportunity for negotiation) Training Schedule:...

RN Clinical Appeals Nurse Job Summary: The RN Clinical Appeals Nurse provides support for internal appeals clinical processes - ensuring that appeals requests are reevaluated in alignment with applicable federal and state regulatory...

Collects data pertinent to the healthcare consumer's health or the situation from telephonic contacts and/or related EMR information available. Analyzes the data to determine the issues and available resources to seek effective resolution.

Job Summary The RN Clinical Appeals Nurse provides support for internal appeals clinical processes - ensuring that appeals requests are reevaluated in alignment with applicable federal and state regulatory requirements, Molina policies...

Company : Highmark Inc. Job Description : JOB SUMMARY This job implements effective complimentary utilization and case management strategies for an assigned member panel.

Job Summary The RN Clinical Appeals Nurse provides support for internal appeals clinical processes - ensuring that appeals requests are reevaluated in alignment with applicable federal and state regulatory requirements, Molina policies...

A healthcare organization is seeking a Maternity Nurse Navigator for their South Boston location. The role focuses on providing comprehensive care in women's health settings including inpatient and outpatient services. Candidates must have a...

A leading health care provider is seeking a Care Manager III based in Chicago, Illinois. This full-time position involves providing care coordination to members through telephonic and field-based management. Candidates must possess a valid nursing...

Description ESSENTIAL FUNCTIONS include the following, other duties may be assigned: Provides health education to families through workshops, parent meetings, handouts, etc. Utilizes and...

A healthcare consulting firm is seeking a Clinical Reimbursement Consultant for a unique remote opportunity. The ideal candidate will be a Registered Nurse with at least five years of experience in MDS completion within a Skilled Nursing Facility.

Job Summary The RN Clinical Appeals Nurse provides support for internal appeals clinical processes - ensuring that appeals requests are reevaluated in alignment with applicable federal and state regulatory requirements, Molina policies...

Registered Nurse Career Opportunity Encompass Health: Where Nursing Meets Heart, Home, and Healing Are you seeking a nursing career deeply rooted in purpose, close to your heart and home? Encompass...

A telehealth practice is seeking a Virtual Registered Nurse to provide high-quality patient care through EMR messaging. This role requires a BSN, an active nursing license, and a minimum of 4 years of clinical experience. You will manage direct...

Registered Nurse (RN) Cadence Health is seeking a dedicated Registered Nurse (RN) to join our team. If you are passionate about providing exceptional patient care, we encourage you to explore this opportunity with us. The ideal...