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Cincinnati Children's is seeking a Utilization Review professional to perform admission and continued stay reviews to determine medical necessity and certification for inpatient stays. The role requires RN licensure with relevant experience and...

Our family of services comprises three distinct mental health treatment programs, including a specialized program for US Veterans. With over 15 unique locations, we manage and support 500+ dedicated employees serving over 300 residential clients...

Capitol Bridge LLC is seeking a Claims Review Nurse to support the Florida Statewide Health Plan CDR program and other state IRO programs. The role involves assessing documentation, coordinating with clinical reviewers, and drafting determinations...

Novitas Solutions, Inc. seeks a Clinical Review Nurse to review and substantiate medical determinations for health claims. You will assess medical necessity, service levels, and appropriateness of care under national and local policies,...

Adecco Healthcare is working with our client in Beverly Hills, CA to hire a Registered Nurse for their elite Beverly Hills plastic surgery practice led by an internationally recognized, board-certified plastic surgeon specializing...

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...

Case Manager Cedars-Sinai has been named to the Honor Roll for the ninth consecutive year and tied for #1 in California and Los Angeles in U.S. News & World Report's "Best Hospitals 2024-25" rankings, as well as placed among the very best...

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...

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.

Opus Medical is seeking a Nurse Liaison to coordinate care and communicate crucial medical information in the United States, specifically in Pensacola, Florida. This remote role involves responsibilities like managing case plans, building...

OU Health seeks an experienced Utilization Review Nurse (RN) to support the Children's Behavioral Health Center. The role involves evaluating medical necessity, coordinating with Payors, and ensuring appropriate hospital stay authorizations after...

Baptist Health is seeking a remote Clinical Documentation Specialist to evaluate physician documentation and ensure accurate illness severity portrayal for coding precision. The role requires an active Kentucky license and involves guiding...

Machinify is seeking a Medical Review Nurse to perform CMS/RAC audits for government payers. This remote role involves working with a multi-location team to review claims, document findings, and support appeals. RAC certification is preferred and...

Fire Department Nurse Educator, Per Diem – Emergency MedicineWork Location: Los Angeles, CAJob #: 28350Work Hours: Varies depending on departmental needsEmployment Type: 6 – Staff- Per DiemDuration: IndefiniteSalary Range: $34.6-70.91...

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...

Allina Health is seeking a Nurse Informaticist to join the Information Systems Optimization Solutions team. The role focuses on integrating nursing practice with data science to improve patient outcomes and care quality across inpatient and...

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.

Housing Advocacy Vocational and Employment (HAVE) in Gaithersburg, MD is seeking a dedicated Registered Nurse/Delegating Nurse (RN/DN) to support individuals with developmental disabilities under Maryland's DDA program. Responsibilities...

Prior Authorizations Nurse (RN) (Temporary) Remote in California OUR COMMITMENT TO A HUMAN HIRING PROCESS We believe every candidate deserves thoughtful consideration.That'swhy we do not use AI or automated...

START Research's START Center for Cancer Research in Los Angeles is seeking a Clinical Research Coordinator, RN to support early-phase oncology trials. The role involves direct patient interaction, data collection, and ensuring protocol compliance...

CVS Health is seeking a Nurse Consultant for Utilization Management in a 100% remote role. You will apply clinical judgment and evidence-based criteria to review inpatient and outpatient services, collaborate with providers to authorize care, and...

Responsibilities Plans, implements, coordinates, and evaluates comprehensive care for designated patients to ensure quality of care and continuity of care delivery through telehealth platforms. QualificationsMinimum...

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.

A healthcare services provider is seeking a Remote Utilization Review Nurse to coordinate clinical resources, ensuring compliance with healthcare standards. Responsibilities include processing authorizations, reviewing documentation, and...

Freeman Health System is hiring for a remote/hybrid position in Utilization Review and Case Management. The role focuses on assisting Emergency Department patients with their social and discharge needs. Candidates must be licensed RNs with strong...