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Description The Appeals Nurse examines medical records and claims information for first-level appeal cases to determine whether services provided were medically necessary and meet Medicare coverage guidelines in accordance with Medicare...

A leading health solutions company is seeking a Care Manager-Registered Nurse in Connecticut. This role requires developing and coordinating care plans for members with multiple chronic conditions while ensuring effective telephonic engagement.

A healthcare organization in California is seeking an RN, Clinical Care Manager I to enhance member care through assessment and coordination. Applicants should have a Bachelor's Degree in a health-related field and an active RN license. The role...

Become a part of our caring community and help us put health first The Care Manager, Telephonic Nurse 2 employs a variety of strategies, approaches and techniques to manage a member's physical, environmental and psycho-social health...

Registered Nurse - Case Review Specialist STGi is currently seeking a Registered Nurse-Case Review Specialist. The position is remote and open to candidates nationwide. Job Summary: Provides direct support...

Say Goodbye to Unpredictable Schedules! Tired of last-minute shift changes, late nights, and weekend work? This is your chance to step into a full-time Registered Nurse role with a Monday-Friday, 8:00 a.m. -...

Job Type Full-time Description Job Summary The Utilization Review (UR) Nurse is responsible for analyzing medical records for medical-legal reviews and producing high-quality, professional executive...

Clinical Appeals & Coding RN Opportunity At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people...

At AHN Healthcare@Home, we're expanding our exceptional care team. In partnership with Allegheny Health Network, we're a nationally recognized leader in home health and hospice care—and a consistent Top Workplace. As a nurse,...

Optum 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. Our deep expertise in the industry and...

A leading health care organization is seeking an experienced RN for a remote Utilization Review role. This position requires at least 2 years of nursing experience and skills in analyzing and determining the appropriateness of patient care levels.

Focus Staff is seeking a travel nurse RN Rehabilitation for a travel nursing job in Dublin, Ohio. Job Description & RequirementsSpecialty:...

A leading healthcare organization is seeking a Clinical Appeals RN to ensure timely resolution of clinical/pharmacy appeals. This role involves collaborating with various teams to analyze clinical cases and provide recommendations. Candidates must...

A healthcare service provider is seeking a Registered Nurse to deliver nursing care to patients in their homes. This role emphasizes coordinating care with other health professionals, ensuring high-quality clinical services, and completing...

Per Diem Emergency Department Based Rn Case Manager This position is a per diem role, providing department coverage and cross trained to cover utilization review and discharge planning as needed. It is eligible for the per diem...

Overview What you can expect! 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...

Overview Join Piedmont to move your career in the right direction. Stay for the diverse teams you'll love, a shared purpose, and schedule flexibility that frees you to live for what matters both in and outside of work. You'll...

Remote Clinical Review Nurse – Prior Authorization Location: Must be located in Central or Eastern time zones Employment Type: Full‑Time About the Role We are seeking an experienced Registered Nurse to join our team...

RN - Utilization Review Nurse | 3+ Years of Experience | Remote in IL | Contract Walker Healthforce is seeking a RN - Utilization Review Nurse with 3+ Years of Experience to support a Healthcare Payor Client based out of IL.

The RN Case Manager is responsible for coordinating continuum of care activities for assigned patients and ensuring optimum utilization of resources, service delivery, and compliance with medical regime. Minimum Requirements ...

A healthcare insurance provider is seeking a qualified individual for a clinical oversight role in Phoenix, AZ. The position requires significant clinical experience, including work with Medicaid/Medicare, and offers a hybrid work model.

Mount Carmel Behavioral Health Hospital is hiring LPN's! Available Schedules PRN Day Full Time Night Pay Range $26.50 to $32.94 per hour (dependent on years of...

A leading healthcare organization in California is seeking a Registered Nurse, Out-Patient Case Manager. This role involves coordinating care for patients with chronic diseases and leading a team of case managers. Candidates should have a valid RN...

Home Care Registered Nurse Case Manager Are you searching for a Purpose? PurposeCare and its affiliate companies are bringing healthcare home; we want you to join our team!

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