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Walker Healthforce, LLC seeks a Medical Claim Review Nurse for a fully remote contract based in Washington. The role focuses on retrospective medical necessity reviews, appeals, and payment integrity within Molina Healthcare of Washington.

A health services provider based in Summit, New Jersey is looking for a compassionate Patient Support Program Nurse. In this remote role, you will provide one-on-one support to patients through phone and digital channels, helping them navigate...

CVS Health is seeking an experienced Utilization Management Nurse Consultant for a 100% work-from-home, full-time position open to MST/PST residents. You will coordinate and document utilization and benefit management activities, ensuring timely,...

Inland Empire Health Plan (IEHP) seeks a Quality Program Nurse to implement and monitor quality management policies under the DHCS framework. Responsibilities include site reviews, medical record surveys, CAP oversight, and HEDIS data abstraction.

UnitedHealth Group is seeking a Nurse Annotator to support AI-powered prior authorization processes. You will review medical records, annotate data, and apply UM guideline criteria to ensure clinically sound labeling for AI training. The...

UnitedHealth Group is seeking a Registered Nurse Clinical Annotator to support AI-driven prior authorization in healthcare. You will interpret clinical data, apply guideline-based criteria, and ensure accurate annotations for model training. This...

Become a part of our caring community At Humana, we put the health and well-being of our members at the center of everything we do. As an Onsite Care Coordination Nurse, you will play a vital role in supporting members during critical moments in...

A staffing and recruiting firm is seeking a HEDIS Nurse (RN or LPN) for a remote position which allows for a flexible schedule. This high-impact role involves ensuring accurate HEDIS reporting and quality improvement initiatives. Candidates should...

A healthcare solutions provider is looking for a qualified RN to perform medical reviews and coordinate care for members. This role involves assessing service needs, engaging in patient education, and ensuring compliance with healthcare...

A healthcare organization is looking for a Senior Clinical Reimbursement Analyst to provide analytical guidance across segments. This role requires reviewing Medicare/Medicaid documentation, ensuring accuracy in MDS coding, and training staff on...

At Amped HQ, we're on a mission to connect top talent with opportunities that drive real impact. We're constantly expanding our global network, seeking the best and brightest to join our team and contribute to our partners' success. With...

Stormont-Vail HealthCare, Inc. is seeking a full-time Registered Nurse for the First Shift (Days) to provide professional nursing care to clinic patients in Topeka, KS. The role follows established practices and emphasizes compassionate care...

Great Lakes Management Company is seeking a Remote Triage RN to cover after-hours triage calls from various sites. This PRN/on-call role requires an RN licensed in MN, WI, or CO, with 5+ years in home health, assisted living, or long-term care...

A leading telehealth provider is seeking a Remote Telehealth Triage Nurse to provide telephone triage and health advice to patients across the United States. Candidates should have a compact nursing license and a minimum of 3 years clinical...

By clicking the “Apply” button, I understand that my employment application process with Takeda will commence and that the information I provide in my application will be processed in line with Takeda's Privacy Notice and Terms of Use. I...

First Coast Service Options is seeking a Clinical Review Nurse to evaluate medical necessity, coverage, and payment levels for Medicare-related claims. The role applies clinical knowledge to determine the appropriateness of care in line with CMS...

UBC is seeking a Telephonic LPN for their call center in a remote US setting. The role delivers telephonic nursing support, patient education, and resource referrals for client-funded programs. Requirements include an associate degree in...

EMD Serono is seeking an experienced RN to join the Patient Support Hub as a remote RN, West Coast-focused. You will provide individualized clinical education, product training, and ongoing support to patients and caregivers, leveraging AI-enabled...

Premera is a health plan seeking a licensed RN for a Care Coordinator - Clinical Appeals role. You will review inpatient, concurrent, and retrospective requests to determine medical necessity and appropriate care across plans. You will...

Affinity Hospice is seeking a Centralized Triage Registered Nurse (RN) to provide remote, telephone-based nursing care for hospice patients and families. You will serve as the primary contact during after-hours, weekends, and holidays across...

Pomelo Care is seeking a Pediatric Triage RN for overnight shifts (9pm–9am ET) to provide patient-centered triage for pediatric cases across the United States. This full-time role involves three 12-hour shifts weekly, with weekend and holiday...

Providence Home Services Oregon is seeking a Clinical Documentation Specialist, Registered Nurse (RN) for a full-time, day-shift remote role open to multiple states. You will review OASIS admission documents and Plans of Care to ensure CMS...

Medcor is seeking a full-time Registered Nurse for its remote 24/7 Occupational Health triage call center. Shifts run 3pm–4am CST, typical days include 8-hour or 10-hour windows, with 40 hours per week and occasional weekend/holiday rotation.

WelbeHealth is seeking an Advocate Nurse, RN to provide continuous care for participants remotely, including after-hours support. This role emphasizes building relationships with participants over time rather than short-term interventions.

Company : Highmark Health Job Summary This job implements effective utilization management strategies including: review of appropriateness of health care services, application of criteria to ensure appropriate resource...