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Sedgwick is hiring for a Clinical Consultation Triage Nurse in a remote, full-time role. You will triage calls, assess needs, and provide care guidance to determine the appropriate level of care, while supporting return-to-work goals. The...

Claims Medical Review Nursing Consultant Job No: 544045 Work Type: Full-time Location: REMOTE OPTIONS, VARIOUS-STATEWIDE, PHOENIX Categories: Healthcare/Medical Support Level,...

Oscar Health is seeking a Utilization Review Nurse to join our team. You will review cases, verify medical records, and consult with care providers to assess treatment appropriateness using Oscar Clinical Guidelines, MCG, and InterQual. The...

Job Summary The Supervisor Nurse Specialty role, is responsible for leading and overseeing a network of contracted nursing agencies supporting home-based and specialty pharmacy services. This role manages nursing contracts and agency...

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...

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...

Western Reserve Area Agency on Aging in North Olmsted, OH is seeking an LPN Community Resource Consultant to assess consumer needs and determine eligibility for WRAAA programs. The role involves educating clients and coordinating with caregivers...

Resp & Qualifications We are looking for an experienced professional to work remotely from within the greater Baltimore metropolitan area. The incumbent will be expected to come into a CareFirst location periodically for...

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...

Overview St. Francis Medical Center is one of the leading comprehensive healthcare institutions in Los Angeles. St. Francis provides vital healthcare services for the 700,000 adults and 300,000 children in our community who count on the...

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...

Diabetes Specialist Nurse Are you a passionate and experienced Diabetic Specialist Nurse looking for flexible and rewarding opportunities? We are inviting skilled professionals to join our Healthcare Professionals Network for a series of...

JOB DESCRIPTION This RN will act as a Care Manager supporting our Michigan Medicaid members, identified with complex medical needs. The Medicaid Care Manager will support them to ensure a successful health outcomes. The position includes...

Clinical Research Nurse I Locations: Los Angeles, California Job Category: Registered Nurse Position Type: Full-Time Shift: Days Job Description Join a team that's...

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,...

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...

Overview St. Francis Medical Center is one of the leading comprehensive healthcare institutions in Los Angeles. St. Francis provides vital healthcare services for the 700,000 adults and 300,000 children in our community who...

Aya Healthcare has an immediate opening for the following position: Outpatient Clinic in Beverly Hills, CA.We'll work with you to build the healthcare career of your dreams. Whether you want a job close to home or across the country, we've got...

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...

Responsibilities: How you'll change lives ...

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.

Back RN/Managed Care Coordinator - Remote Healthcare Columbia , South Carolina Contract Hybrid Oct 9, 2026 RN/Managed Care Coordinator - Remote Job at a Glance Title:RN/Managed Care...

Maximus is seeking a Clinical Reviewer (LPN) to support Illinois PASRR Level I screenings in a fully remote role. You will review clinical documentation, coordinate with providers, and ensure HIPAA compliance. You will collaborate with a...

CVS Health is seeking a Nurse Consultant for Utilization Management in a 100% remote capacity. The role reviews inpatient and outpatient services using evidence-based criteria, authorizes care with providers, and escalates cases as needed.

Healthcare Executive Placements, Inc. (HCEPInc.) is seeking an InterimRN Quality & Safety Improvement Consultant for a 13-week W2 contract in Baldwin Park, CA. The role focuses on clinical quality, patient safety, regulatory readiness, and...