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Arkansas Blue Cross Blue Shield is seeking an Utilization Management Nurse to perform clinical reviews for prior approvals, network exceptions, benefit inquiries, and admissions. The role evaluates medical necessity using evidence-based criteria...

Dimensional Health Care Associates, Inc. (DHCA) seeks an RN Case Manager/Delegating Nurse in Bowie, MD to manage client care and delegate tasks. The role includes travel to client homes, initial and periodic assessments, and coordination with...

Licensed Practical Nurse (LPN) – Principal Care Management (PCM) Join Elaya Health – Improving Specialty Care in Nursing Homes Remote Position Full Time / Part Time Available Work From Home Competitive Compensation Elaya...

Telehealth Nurse Practitioner (APRN) for our Skilled Nursing and Post-Acute Facilities - Remote, covering Kentucky, West Virginia, and Ohio Compensation: $105,000 - $125,000 Annual Salary Benefits: Medical, dental, vision, life...

Case Manager Specialty RN - Oncology/RadiologyWorks collaboratively with an assigned panel of physicians to manage the patients specialized needs. The managing team does differ according to the chronic disease. Duties include assessment to...

Cambia Health Solutions, Inc. is seeking an Utilization Management Nurse to perform prospective, concurrent, and retrospective reviews for member care across multiple states. The role emphasizes applying clinical criteria, ensuring medical...

JOB PURPOSE: This position is responsible for conducting medical management and health education programs for customers on government health care programs. Accountabilities include gathering, analyzing and providing date for regulatory...

Clinical Triage Specialist (CTS) (RN) - Access Center St. Luke's is proud of the skills, experience and compassion of its employees. The employees of St. Luke's are our most valuable asset! Individually and together, our employees are...

Nurse Researcher Baystate Medical Center is seeking a per diem Nurse Researcher to advance nursing scholarship, evidence-based practice, and clinical innovation. This role supports the development, implementation, and evaluation of...

Centene is seeking a RN/UM Supervisor to oversee Prior Authorization, Concurrent Review, and Retrospective Review teams, ensuring compliant and quality care for members. The role collaborates with the UM team and senior management to improve...

Nurse Case Mgr II (RN) role at Elevance Health offers virtual, full-time care management for members with complex needs. The position emphasizes risk stratification, planning, implementation, and transition of care to optimize outcomes and access...

CVS Health is seeking a Behavioral Health Utilization Management Clinician for a 100% remote, nationwide role. You will review preauthorization requests, coordinate decisions with providers, and apply clinical judgment to ensure timely,...

Company Overview: Join us in our mission to transform healthcare! nirvanaHealth (under RxAdvance Corp.) is committed to bringing the art of the possible to the payer and PBM industries. We invest in our employees at every stage...

HealthEdge is seeking a Registered Nurse to coordinate utilization/benefit management for health plans in a remote US role. The candidate will review authorizations, coordinate care plans, and communicate with providers to ensure medical necessity...

Job Summary This position is responsible for ensuring compliance with Utilization Management (UM) and Quality Review (QR) functions performed by the health plan. The role supports clinical review activities requiring 5+ years of experience...

You coordinate comprehensive care plans for patients in a remote environment. You advocate for patient needs and help navigate healthcare resources. Key Responsibilities: Perform telephonic nursing...

Nascentia Health is seeking an Licensed Practical Nurse to support Health Plan Health Support within Care Management. This fully remote role requires NY licensure and periodic travel to the nearest office. You will triage calls, educate...

Clinical Review Nurse - Concurrent Review TX All On-site Share on Job Description Location: 100% Remote - TX: RN only with TX license SHIFT: Tuesday – Saturday 8am-5pm CST- schedule is firm- no flexibility...

The University of Kansas Health System at the Southlake Campus in Lenexa, KS seeks a Registered Nurse (RN) – Procedural Scheduling Nurse Coordinator to oversee daily scheduling operations in designated procedural areas. Under the direction of...

Details Client Name PIH Health Hospital - Downey (FKA Downey Regional Medical Center and Downey Medical Group) Job Type Travel Offering Nursing...

WellSky is seeking a registered nurse to conduct telephonic patient evaluations for multiple payer programs, working on Pacific Time hours. The role emphasizes remote care coordination, schedule management, and collaborative protocol development.

Sedgwick is hiring a Telephonic Case Manager for a US-based, remote role. The position focuses on partnering with injured workers, employers, and medical providers to create case management strategies that facilitate recovery and a successful...

Telephonic Nurse Case Manager: California RN License (Remote) Department: Claims Administration & Adjusting Employment Type: Permanent - Full Time Location: Home United States Reporting To:...

Northern Light Home Care and Hospice is seeking RN nurses for PRN, traveler-like assignments in Ellsworth, ME, with remote options. Positions are 12-week temporary per diem roles, with potential transition to permanent full-time, part-time, or...

Netsmart Technologies, Inc. is seeking a Registered Nurse with utilization management experience to review ED admissions and apply InterQual/MCG criteria for medical necessity. You will discuss documentation with ED physicians and ensure proper...