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Health Care Service Corporation is hiring a Nurse Liaison I for Utilization Management & Quality Review. This remote nationwide role supports clinical review activities, benefit determinations and medical necessity assessments, ensuring compliant,...

Public Consulting Group LLC (PCG) is a leading public sector solutions implementation and operations improvement firm that partners with health, education, and human services agencies to improve lives. Founded in 1986, PCG employs approximately...

PACE Early Childhood Education Program Consultant PACE Early Childhood Education (ECE) Program provides high quality early childhood education and support services for children aged 0-5 years old children for economically disadvantaged...

Float Health is hiring a Recurring Care Specialist for a fully remote US position. You will coordinate nursing visits with pharmacies, nurses, and patients, managing scheduling and communications across multiple platforms. The role...

Nurse Consultant I (NS) The North Carolina Department of Health and Human Services (DHHS) is one of the largest, most complex agencies in the state, and has approximately 17,000 employees. It is responsible for ensuring the health,...

Are you looking for an exciting way to utilize your nursing skills and expertise to deliver quality nursing care in a remote setting? AccessNurse, where technology meets compassionate care, is looking for professional nurses & offering...

CorVel Corporation seeks a Care Advocate Nurse for a remote role focused on assessing injury severity, reviewing medical data, and supporting the Claims Management department as a nurse consultant. The position requires clinical nursing...

Our client, a Medical Center facility under the aegis of a California Public Ivy university and one of largest health delivery systems in California, seeks an accomplishedInfusion Referral Intake...

ICU Medical Inc is seeking a Customer Success Nurse Consultant to drive post-implementation success for infusion devices through clinical expertise and data-driven consulting. You will partner with healthcare organizations to optimize medication...

Health Care Service Corporation seeks a Quality of Care (QOC) Nurse to review and investigate potential quality of care issues in a timely manner. This role supports QA activities in line with CMS and NCQA requirements, under the supervision of...

Improve the lives of others while Caring. Connecting. Growing together. Job Description - Clinical Grievances RN - Remote in CA (2381848) Clinical Grievances RN - Remote in CA - 2381848 At UnitedHealthcare, we're simplifying the...

Cambia Health seeks an Appeals Clinician I to evaluate member and provider appeals using nursing expertise and clinical judgment. This remote role supports multiple states and emphasizes medical policy, reimbursement guidelines, and compliance.

Serving as the strategic quality advisor for a portfolio of Value-Based Care organizations, the full-time Lead VBC Quality Consultant will analyze performance, develop quality improvement strategies, and partner with provider organizations to...

Central California Alliance for Health is seeking a Prior Authorizations Nurse (RN) for a temporary, full-time role. This remote-in-California position reports to the Utilization Management Supervisor and involves ensuring PA requests comply with...

About the Role: The Nurse Auditor, Regulatory Reimbursement and Reporting is responsible for conducting clinical, revenue integrity, and compliance audits to ensure accurate charge capture, documentation integrity, coding compliance, and...

Department: Claims Administration & Adjusting Location: Home United States Description Our Story Imagine being part of a team that's not just shaping the future but actively driving it. At Davies North...

Registered Nurse (RN) - Utilization Management Make an impact on patient care from wherever you are. We're seeking an experienced Registered Nurse (RN) to join our Utilization Management team. In this role, you'll use your clinical...

RN Health Care Facility Surveyor - New Mexico (#1168) Employee retirement plan (401k) with a generous match and immediate vesting Company-issued and company-paid Amex...

Cattail Nurse Consulting is seeking an MDS Consultant/Nurse Consultant to provide MDS coordination, interim remote coverage, and training for skilled nursing facilities and senior living clients. This full-time RN role emphasizes education, mock...

Fuze Health seeks a Registered Nurse to support the FuzeRx Central Operations telehealth care team. This remote role focuses on ensuring Medicare member compliance with a new Stars measure and confirming ED discharge success, with additional HEDIS...

Vail Health is seeking a Triage Nurse (Remote) to perform care coordination and triage nursing functions. You will assess patient health concerns using protocols and support triage via calls and patient portal messages. Responsibilities...

Clinical Nurse Consultant At Bristol Myers Squibb, our employees often ask, "Who are you working for?"—a question that fuels collaboration, accountability, and urgency in our work. Our purpose-driven culture inspires us to discover,...

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,...

Humana is seeking a Utilization Management Registered Nurse to interpret and support coordination, documentation, and communication of medical services and benefit determinations. You will rely on established criteria to determine appropriateness...

Amergis Healthcare Staffing seeks a Clinic Registered Nurse (RN) for a contract-full time role based in Kingfisher, OK. The RN will work across clinic and immunization settings, providing quality care with clinical judgment per facility protocols.