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Join the transformative team at City of Hope, where we're changing lives and making a real difference in the fight against cancer, diabetes, and other life-threatening illnesses. City of Hope's growing national system includes its Los Angeles...

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

IQVIA is seeking a Flex Nurse Educator to deliver remote patient education and in-field support during territory vacancies, supporting adherence and disease management. This is a non-clinical, educational role requiring an active RN...

Nurse Practitioner Works in collaboration with physicians and within written guidelines to provide complete physical examinations, diagnosis, and treatment of both chronic and episodic disorders. Essential Job Functions: ...

Children's Mercy Job Opportunity Do you envision finding a meaningful role with an inclusive and compassionate team? At Children's Mercy, we believe in making a difference in the lives of all children and shining a light of hope to the...

CVS Health Corporation is seeking a RN-qualified professional to lead quality improvement initiatives and performance measurement within POSC, aiming to meet HEDIS and CAHPS goals. The role involves analyzing clinical workflows, implementing...

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 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...

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...

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...

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...

DRG Specialist UPMC Corporate Revenue Cycle is hiring a DRG Specialist to work on inpatient auditing within our Coding Department. This position will be a work-from-home position working during standard business hours Monday through...

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...

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...

Your Future Role At A Glance Location: Remote Facility: Ascension Wisconsin Hospitals Department: Clinical Integrity Documentation Schedule: Days | Full-Time Salary Range: $79,511.52-$110,834.59 How...

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...

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...

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...

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...

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.

Family Advocate Support Care - Senior Clinical Admin 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...

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,...

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 better. Come build the health care system...

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...