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Utilization Management Nurse Consultant We're building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you'll be surrounded by passionate colleagues...

Piper Companies is seeking a Clinical Appeals Nurse for a fully remote, long-term contract in the healthcare sector. The role focuses on clinical review, appeal resolution, regulatory compliance, and member/provider support within a complex health...

Experience 2-5 years needed. Every effort has been made to identify the essential functions of this position. However, it in no way states or implies that these are the only duties you will be required to perform. The omission of specific...

Comagine Health in Alabama is seeking Clinical Utilization Review Nurses (RN) to assess medical necessity and quality of care through prospective, concurrent, and retrospective utilization reviews. This is a full-time remote role supporting...

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...

Cunningham Children's Home is seeking a Nurse Case Manager to support youth in emotional, psychological, and physical care within residential settings. The position emphasizes remote on-call consultations to ensure accessibility without mandatory...

Clinical Appeals Nurse We are seeking an experienced Clinical Appeals Nurse to support the appeal and grievance processes by analyzing and responding to adverse coverage decisions. This role involves clinical judgment, regulatory...

The Utilization Management Nurse Reviewer plays a crucial role in healthcare systems by ensuring that medical services are used efficiently and appropriately. They review medical records, treatment plans, and patient information to determine the...

Too many women spend years being told their pain is normal. They wait a long time for a diagnosis, cycle through treatments that do not work for them, and often end up managing debilitating symptoms on their own. At Montu, we see these patients...

Concurrent Review Registered Nurse (RN) Location: Fully remote. Our client is seeking an experienced Concurrent Review Registered Nurse (RN) to join its Utilization Management team. In this role, you will perform concurrent...

Provides direct nursing care including assessment, plan of care, education, and evaluation for assigned patients. Performs patient duties necessary to maintain the...

Healthcare Provider Solutions is seeking a Clinical Consultant to join our remote clinical consulting team. The role focuses on hospice quality assurance, chart reviews, and Medicare hospice issues, including ADR/UPIC/SMRC/OIG audits.

Optum is seeking a Clinical Consultant RN, Medical Policy Writer for a remote role within the United States. You will lead clinical oversight of product medical policies, develop utilization guidelines, and support COE network criteria. The...

Humana is seeking a Pre-Authorization Nurse to review requests for medical necessity and level of care, working remotely from Virginia or a compact-licensed state. You will educate providers, document clinical data, and make independent...

Utilization Review Nurse Auditor Fully Remote • Mount Laurel, NJ 08054 Salary Range $33.00 - $46.00 Hourly Position Type Full Time Travel Percentage 10% ExamWorks is looking for a Utilization Review Nurse Auditor to join...

Summit provides independent insurance agents and their clients with market-leading workers' comp insurance and elite customer service. We're growing and currently serve more than 7,000 independent agents and 31,000 policyholders across the South,...

Job Summary and Responsibilities As our Educator, RN in Periop, In accordance with our mission and core values of integrity, compassion, collaboration, and excellence, this position is established to serve as a...

We are seeking to hire an IP Nurse to join our team! We are a skilled nursing facility looking for dynamic associates to join our clinical team and provide our residents with a best-in-class care experience! Whether you are just starting your...

Clinical Facility Site Review Support Provides support for clinical facility site reviews. Under the supervision of leadership, uses clinical judgement within appropriate scope to independently conduct reviews and other monitoring...

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...

Abbott is seeking a per-diem RN trainer in the Durham, NC area to deliver Face-2-Face training for home testing customers. You will guide finger stick collection, explain PT/INR device use, and assist with reporting responsibilities. The...

Northwell Health is seeking a Registered Nurse CDI Auditor to validate acute inpatient coded charts and ensure documentation substantiates diagnostic information. This remote position in New York requires a NY RN license, a BSN, and strong...

It takes great medical minds to create powerful solutions that solve some of healthcare's most complex challenges. Join us and put your expertise to work in ways you never imagined possible. We know you've honed your career in a fast-moving...

Responsibilities SafeGuard Services (SGS), a subsidiary of Peraton, performs data analysis, investigation, and medical review to detect, prevent, deter, reduce, and make referrals to recover fraud, waste, and abuse.

Remote Review Nurse SUMMARY DESCRIPTION: The review nurse is responsible for medical record abstractions and overreads during the annual Healthcare Effectiveness Data and Information Set...