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Professional Review Nurse The Professional Review Nurse provides analysis of medical services to determine appropriateness of charges on multiple types of medical bills and review of medical reports to determine appropriateness of medical...

Performs under the supervision of a licensed nurse, provides individually assigned patient care activities based upon established patient care policies, procedures, state, federal, and regulatory board requirements. Active and enthusiastic member of...

Excel. Empower. Advance. Shine. Belong. Explore. Flourish. Champion. Make It Happen At Hopkins! Johns Hopkins Health Plans (JHHP) is the managed care and health services business of Johns Hopkins...

Evenings, Weekend Only, Full-time & Part-time opportunities available (20hrs +) Hiring for evenings and weekends (*weekends and holidays are required) Incentives for Bilingual Spanish Telephone Triage RNs! Are you looking for an...

Job Title : Registered Nurse (Navy Nurse Corps) Category / Component : Officer • Both Overview Navy Nurse Corps officers deliver professional nursing care to service members, families, and global communities in leading edge military medical...

Overview:Our client, a mutual benefit corporation and health plan provider, seeks an accomplished Appeals and Grievance RN .*** Candidate must be authorized to work in USA without requiring sponsorship...

Remote Rn – Medical Claims Reviewer At Broadway Ventures, we transform challenges into opportunities with expert program management, cutting-edge technology, and innovative consulting solutions. As an 8(a), HUBZone, and Service-Disabled...

Job Description: The Intake Coordinator is a Registered Professional Nurse who takes referrals and processes appropriate home care services. To maintain open lines of communication with referral sources and within Americare...

Are you an internal caregiver, student, or contingent worker/agency worker at UMass Memorial Health? CLICK HERE to apply through your Workday account. Exemption Status: Exempt Hiring Range:...

Join Equum Medical and be a driving force in revolutionizing acute care telehealth. As an innovative leader in the healthcare technology industry, Equum Medical is dedicated to transforming how patients access critical medical services.

Medical Review Nurse Analyst Our Medical Review Nurse Analyst - Registered Nurse (RN) is responsible for reviewing medical records to determine whether services are payable based on TRICARE policy, reference materials, and evidence-based...

Job Description: Participates in the development and ongoing implementation of QM Work Plan activities. Improve quality products and services, by using measurement and analysis to process, evaluate and make...

School Nurse Published Date: Jun 8, 2026 Location: US Company: Los Angeles Unified School District SALARY DETAILS All Salary Tables located at School Nurse Salary Table - N Table APPLICATION FILING DATES...

Join Martin's Point Health Care - an innovative, not-for-profit health care organization offering care and coverage to the people of Maine and beyond. As a joined force of "people caring for people," Martin's Point employees are on a mission to...

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...

RN Clinical Staff Nurse-EmPATH-Full Time Days Event Details Join us for an Interview and Hiring Day! Registered Nurses welcomed! Location: 1680 E. 120th Street, Los Angeles, California 90059...

Registered Nurse (RN) - Clinical Documentation Specialist (Part Time) Remote The Clinical Documentation Specialist is responsible for the evaluation of physician documentation utilizing their clinical expertise to ensure the patients'...

City/State Norfolk, VA Work Shift Multiple shifts available Overview: Sentara Health Plansis hiring a Quality Improvement Coordinator /Registered Nurse (RN) - Remote in Virginia! ...

Description Position at Northwell Health PART TIME- 20 hours per week- Mon-Fri 8pm- 12am shift- Rotating weekends and holiday coverage expected! Northwell is the largest not-for-profit...

Nurse Reviewer At Commence, we're the start of a new age of data-centric transformation, elevating health outcomes and powering better, more efficient processes to program and patient health. We combine quality data-driven solutions that...

Discharge Care Manager (Central or Eastern Region) Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes...

Clinical Review Nurse Duals Program Details- Brand new program of 2026 for Centene Duals = Medicare + Medicaid line of business. Members have one combined card and one authorization covering both benefit types. The duals...

We believe everyone should have confidence in navigating their healthcare. We are looking for a qualified Registered Nurse (RN) to serve our patient population in the navigation, prevention and management of their health through continuous care...

Requisition Details GENERAL REQUISITION INFORMATION EEO Statement: UNMC is an Equal Employment Opportunity Employer, including an equal opportunity employer of protected veterans and...

Scion Nonprofit Staffing has been engaged to conduct a search for a Registered Nurse (RN) - Research for a mission-driven clinical research organization advancing equitable healthcare access and innovative treatment...