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Clinical Quality Specialist We are seeking a dedicated Clinical Quality Specialist to ensure regulatory and accreditation compliance. The ideal candidate will maintain alignment with DHCS, NCQA, and CMS requirements through ongoing...

City/State Virginia Beach, VA Work Shift Second (Evenings) Overview: Sentara is hiring Registered Nurses for the Innovative Inpatient Care Model in the Brand-New Centralized Virtual Acute...

Medical Analyst We are seeking Medical Analysts with experience in preparing Medicare Set Asides and Medical Cost Projections. This includes reviewing records, preparing the narrative and an appropriate allocation for medical treatment...

Job Description: Participates in the development and ongoing implementation of QM Work Plan activities. Improve quality products and services, by using measurement and analysis to process, evaluate and make...

Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy. AZ Blue offers a variety of health insurance products and services to meet the diverse needs of individuals, families,...

Scion Nonprofit Staffing has been engaged to conduct a search for a Registered Nurse (RN) - Research for a mission-driven clinical research organization advancing equitable healthcare access and innovative treatment...

OverviewPosition Type: Full timeJob Title: Care Review Clinician ILocation: 100% Remote (Must reside in one of the following states: NV, AZ, FL, GA, ID, IA, KY, MI, NE, NM, NY (outside greater-NYC), OH, TX, UT, WA (outside greater-Seattle),...

Nurse Reviewer Appeals and Hearings- Remote 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...

Clinical Review & Correspondence RN The Clinical Review & Correspondence RN plays a critical role in supporting utilization management operations by conducting medical necessity reviews, preparing clear and compliant clinical...

Overview The Legacy/OHSU Interventional Radiology practice provides services at four locations (EMC, GSMC, MHMC and MPMC) including ambulatory clinics at each site. The IR team cares for both adult and pediatric patients with...

L.A. Care Health Plan is seeking a Delegation Oversight Clinical Auditor RN II in Los Angeles, California. The role involves ensuring compliance with Utilization Management regulations and performing various audits. Applicants must possess an...

Job Description Registered Nurse - Full Time - Home Health (Florence County) *$15,000 with 2 years commitment Sign On Available! Responsibilities ...

Requisition number: 2367947 Job category: Nursing Optum NY, is seeking an RN Case Manager to join our team anywhere within the U.S. Optum is a clinician-led care organization that is changing...

Remote Rn – Medical Claims Reviewer At Broadway Ventures, we transform challenges into opportunities with expert program management, cutting-edge technology, and innovative consulting solutions. As an 8(a), HUBZone, and Service-Disabled...

RN - Clinic Nurse Out-patient clinic nurse City: Los Angeles State: CA Start Date: 01/06/2025 End Date: 04/07/2025 Duration: 13 Week(s) Shift: 5X8 Days Shifts Per Week: 5 Scheduled...

Job Opportunity Home Health Care, Hospice Care, Palliative Care, Long Term Care, Rehab No weekends, no afterhours support, no holidays Job Summary Are you seeking a unique nursing position that gives you a great...

When you join the growing BILH team, you're not just taking a job, you're making a difference in people's lives. This position is remote. Candidates must be local to New England States for...

Telephonic Registered Nurse 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...

Job Title Utilizes a collaborative review process of benefits, minimally necessary clinical information and evidence-based clinical guidelines to formulate decisions regarding medical necessity, pre-existing conditions, benefits and/or...

Join Martin's Point Health Care - an innovative, not-for-profit health care organization offering care and coverage to the people of Maine and beyond. As a joined force of "people caring for people," Martin's Point employees are on a mission to...

RN Diabetes Educator Sanford Health, the largest rural health system in the United States, is dedicated to transforming the health care experience and providing access to world-class health care in America's heartland. Facility: Bemidji...

Registered Nurse (RN) - Clinical Documentation Specialist (Part Time) Remote The Clinical Documentation Specialist is responsible for the evaluation of physician documentation utilizing their clinical expertise to ensure the patients'...

Utilization Review Nurse Remote Ability to travel on-site to 3031 NE Stephens St., Roseburg OR, 97457, as needed for business operations. Employment Type: Full-Time, Exempt About Umpqua Health At Umpqua Health, we're more...

RequirementsHigh school diploma or GEDSuccessful completion of a certified nursing assistant programFingerprint clearance and negative TB skin test or chest x-rayMinimum one (1) year of documented experience is requiredResponsibilitiesProvide...

Join Equum Medical and be a driving force in revolutionizing acute care telehealth. As an innovative leader in the healthcare technology industry, Equum Medical is dedicated to transforming how patients access critical medical services.