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Talantir seeks a Quality Assurance Nurse to evaluate patient care quality, ensure regulatory adherence, and promote infection prevention. The role operates remotely within the USA with an hourly rate of $38–$40 depending on experience.

NTT DATA is seeking a BPO Clinical Review Specialist in the United States, with remote work available for Florida residents. The role requires an active RN license (Florida or Compact) and at least 3 years of appeals, utilization management, or...

Baptist in Meridian, MS seeks a Specialist-Clinical Documentation III RN to evaluate day-to-day documentation practices and advise the clinical team on accurate diagnoses and coding. The role requires five years of acute care experience,...

Amerit Consulting is seeking an experienced Utilization Management Nurse (RN) in California for a remote 6-month contract. The incumbent will support inpatient utilization review, medical necessity determinations, and facility claims compliance,...

Location United States of America-USAUS Job Description Are you interested in joining a team of experienced healthcare experts and have the ability to shape and transform the healthcare delivery system? At our family of...

Providence Tarzana Medical Center in Tarzana, CA is seeking a Certified Nursing Assistant for the Cardiovascular Unit. This Full-Time role requires CA Nursing Assistant Certification, BLS, and completion of the Nursing Assistant course, with...

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...

Iconma Portal is seeking a Registered Nurse-Review Analyst for a remote position with a Health Insurance client. You will conduct prospective, concurrent, and retrospective reviews across inpatient, outpatient, ambulatory, and ancillary services...

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...

State of North Carolina - Health & Human Services in North Carolina seeks a Nurse Consultant I who conducts regulatory nursing home inspections to ensure compliance with federal and state standards. The role involves travel across Central and...

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...

Grievance & Appeals Nurse, RN Find joy in serving others with IEHP! We welcome you to join us in "healing and inspiring the human spirit" and to pivot from a "job" opportunity to an authentic experience! Reporting to the...

ExamWorks is seeking a Utilization Review Nurse Auditor to perform quality utilization reviews and authorize medically necessary care. The role is fully remote with standard EST hours, requiring an active nursing license and coding certification.

CVS Health is recruiting for an RN Concurrent Review Nurse in a remote capacity, focusing on inpatient clinical expertise to ensure medically necessary care across the continuum. The role requires an active RN license and 5+ years of...

Ochsner Health, a leading not-for-profit healthcare provider in the Gulf South, seeks an experienced RN for a remote case management role. You will coordinate care by liaising with patients, caregivers, multidisciplinary teams, and payers to...

SCAN is seeking an HEDIS Nurse to review medical records for Quality Initiatives/NCQA reporting. The role involves outreach to members and providers to ensure complete data and adherence to NCQA guidelines, with a focus on medication adherence and...

UCSF Health Medical Foundation is seeking an experienced Primary Care Telephone Triage Registered Nurse to work remotely from home. The role requires a California RN license, at least two years of full-time triage or acute care RN experience, and...

Clinical Documentation Quality Improvement (CDQI) Specialist, you will play a pivotal role in elevating the impact of our medical record documentation. You will conduct daily evaluations and engage in direct communication with providers to enhance...

American Health Plans Franklin, TN 37067, USA Description American Health Plans, a division of Franklin, Tennessee-based American Health Partners Inc. owns and operates Institutional Special Needs Plans (I-SNPs) for...

Essentia Health Moose Lake Clinic is seeking a licensed registered nurse for the Family Practice team. The role emphasizes primary care, triage, and coordination of care for individuals, families, and communities in outpatient settings.

Centene Management Company LLC is seeking a Licensed Practical Nurse to analyze prior authorization requests and determine medical necessity in New York. You will work with healthcare providers and the authorization team to ensure timely,...

A healthcare staffing company in Torrance, CA is seeking a Senior Healthcare Recruiter for a remote RN position. The ideal candidate will have at least 1 year of Home Health experience and must possess an active CA RN License. Responsibilities...

About HCSC At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers. Join HCSC and be...

As a Clinical Documentation Review Specialist (RN), you will help medical staff clarify patient records to ensure appropriate reimbursement and reflect care complexity. You will perform concurrent reviews and engage with physicians...

Family Service of Rhode Island (FSRI) seeks a per diem School Nurse to join our multidisciplinary team in Exeter, RI. The nurse provides healthcare services to students and staff, manages health needs, responds to emergencies, and supports...