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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...

To support an upcoming clinical project, experienced Registered Nurses (RNs) will find a fully remote contract opportunity as a Remote RN Clinical Consultant, focusing on conducting comprehensive medical record and clinical chart reviews while...

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...

The Clinical Quality Assurance Coordinator is responsible for ensuring case reports are of the highest quality and integrity, and in full compliance with client contractual agreements, regulatory agency standards and federal and state mandates.

*This role will require the successful candidate to work the shift of Monday to Friday, 1pm to 10pm Central (2pm to 11pm Eastern). The Utilization Review Clinician is responsible for reviewing medical records to determine medical necessity. This...

Job Title: Clinical Prior Authorization Reviewer Job Description This role focuses on reviewing prior authorization requests to determine medical necessity and appropriate level of care in alignment with national standards,...

1st TIME OK/ 2 YR EXP required for Utilization Review RN every other weekend required or more depending on unit needs no call or floating required MUST HAVE experience with Milliman Care Guidelines and Acute Hospital Experience!! The Emergency...

Our client, a mutual benefit corporation and health plan provider, seeks an accomplished Registered Nurse (Utilization Management). *** Candidate must be authorized to work in USA without requiring sponsorship...

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...

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...

State of Washington's Nursing Consultant role conducts investigations and inspections for Region 1C to ensure long-term care providers meet WAC and RCW requirements. This highly independent position manages a worklist, travels to facilities, and...

Iris Telehealth is hiring PMHNPs for 100% remote consult-liaison telepsychiatry in Texas. Earn $120/hr with a sign-on bonus, working 13–16 overnight shifts per month, including weekends. Roles require Texas PMHNP licensure, 2 years...

At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers. Join HCSC and be part of a...

Job Opportunity At The Samuel Oschin Cancer CenterDo you have a passion for the highest clinical quality and patient happiness? Would you like to use your expert clinical competencies with an organization known nationally for excellence in cancer...

About This Role The Clinical Consultant RN, Medical Policy Writer role at UnitedHealth Group involves providing clinical leadership for assigned Optum products, focusing on the development of clinical utilization management guidelines and...

This position is offered fully Home based (Remote) As a pharmaceutical support industry leader, UBC is devoted to empowering health solutions for a better tomorrow. We take pride in improving patient outcomes and advancing healthcare. At UBC we...

Utilization Review Nurse - RN | 100% Remote | Part-Time10-20 Hours Per Week | Flexible Schedule | Evenings & Weekends Looking for a way to use your nursing experience without returning to a full-time bedside schedule? We're...

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,...

SCAN Health Plan seeks a HEDIS Nurse to review medical records and support NCQA-driven quality initiatives. This remote role coordinates with members and providers to collect complete data, focusing on medication adherence and preventive...

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 who care deeply, innovate with purpose, hold...

Humana is seeking a Pre-Authorization Nurse to review and authorize care requests in a remote role based in Virginia or a compact-license state. You will evaluate medical necessity, coordinate with internal stakeholders, and educate providers on...

Nurse Appeals Location: Nashville Tennessee (This role is open only to residents of Tennessee). Virtual: This role enables associates to work virtually full-time, except for required in-person training sessions, providing maximum...

Clinical Grievances Nurse At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the...

Everlywell is a digital health company pioneering the next generation of biomarker intelligence-combining AI-powered technology with human insight to deliver personalized, actionable health answers. We transform complex biomarker data into...

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 who care deeply, innovate with purpose, hold...