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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.

Description You're a nurse, a patient advocate, and an educator-and you excel at every one of them. In this role, you will be responsible for providing inbound and outbound patient support in a...

EMD Serono is seeking a RN Patient Support Specialist – West Coast to join the Patient Support Hub. This remote role delivers individualized clinical education, product training, and ongoing support to patients and caregivers, across multiple...

Broadway Ventures, a veteran-owned SDVOSB headquartered in Mississippi, seeks an experienced Registered Nurse to perform medical review of complex claims, pre-authorization requests, appeals, and fraud referrals. You will apply clinical expertise...

UnitedHealth Group is seeking an Inpatient Utilization Management Nurse, RN for a fully remote role serving the Sacramento area. The position requires 3+ years in acute care and 1+ year in utilization management, with certification in RN licensure...

Sr. Clinical Coding Nurse ConsultantExplore opportunities with WellMed, part of the Optum family of businesses. We believe all patients are entitled to the highest level of medical care. Here, you will be part of a team who shares your passion for...

hireops is seeking a contract role for a discharge care coordination position in Chicago, IL. This role involves responsibilities for episodic case management and counseling, ensuring follow-up for acute conditions. Qualified candidates...

A healthcare technology company is seeking an experienced On-Call Registered Nurse (RN) for a remote, part-time position. This role offers flexibility and the opportunity to support patient care from home. Candidates must possess a current Compact...

Cambia Health Solutions is seeking a Remote Care Management Nurse to provide comprehensive clinical care management, including case management, for members in Idaho and surrounding states. Candidates must be Registered Nurses with a minimum of 3...

A health care provider organization is seeking a Case Management Nurse to coordinate care for members. This role requires a Nursing Diploma and direct clinical experience, along with the current Michigan RN license. Responsibilities include...

A healthcare service provider is seeking an Appeals and Grievances Clinical Specialist to manage member complaints and clinical case resolutions. This is a 100% remote role requiring an RN, LPN, or Dental Hygienist license. Responsibilities...

A healthcare network is seeking a full-time Registered Nurse for Pre-Admission Testing (PAT) to work remotely. The role involves conducting comprehensive pre-operative assessments, coordinating with the medical team, and ensuring patient readiness...

DaMar Staffing is seeking a Registered Nurse (RN) to review and evaluate medical necessity, appropriateness, quality, and compliance of services rendered by providers. The role covers claims analysis, provider audits, fraud detection, and...

Gainwell Technologies is seeking a Medical Reviewer (Registered Nurse) to support California healthcare programs. You will use clinical judgment to review medical records, healthcare services, claims, and authorization requests. You will...

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...

Hartford, CT – Seeking RN – Patient Care Coordinator Be The Patient Care Coordinator You Are Meant To Be As a Patient Care Coordinator, you play a vital role in our mission to improve lives.

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 experience! Under the direction of the...

City/State Roanoke, VA Work Shift First (Days) Overview: Sentara Health Plans Roanoke is looking to hire a Care Coordinator- LPN. Sentara Health Plans is hiring a Remote Care...

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...

RWJBarnabas Health is seeking an experienced Registered Nurse for a remote, day-shift role in New Jersey. The RN will support virtual urgent care navigation, referrals, and care coordination while working with a multidisciplinary team to ensure...

Allina Health is seeking a Daytime RN Triage for a fully remote position with orientation. The role supports centralized nursing programs, triage services, anti-coagulation and refill in an outpatient clinic setting. Candidate must live...

UVA Health is seeking a Registered Nurse (RN) in Utilization Management for a remote role. You will leverage acute care experience to navigate complex clinical scenarios, determine medical necessity, and collaborate with interdisciplinary teams.

Palo Verde Community College District is seeking an experienced Clinical Documentation Integrity (CDI) Specialist (RN) for a fully remote role based in the US. The position supports quality outcomes, reimbursement accuracy, and regulatory...

Overview Provide clinical nursing expertise to support the training and evaluation of healthcare-focused AI systems. Review, annotate, and evaluate clinical data, including patient records and care scenarios. Translate real-world nursing...

A global talent management firm is seeking a Utilization Review Nurse for a contract role based in Pennington, NJ. The role involves performing utilization management, reviewing medical records, and coordinating discharge planning. Candidates must...