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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,...

Position Purpose: Performs concurrent reviews, including determining member's overall health, reviewing the type of care being delivered, evaluating medical necessity, and contributing to discharge planning according to care policies and...

Jefferson City Medical Group is seeking a Licensed Practical Nurse for Medication Management in Jefferson City, MO. This remote-friendly role supports a centralized medication management office with responsibilities including handling refill...

Utilization Review Specialist (RN) – Work From Home (Florida-Based Candidates Only)Concierge Home Care | Work From Home Opportunity – Must Reside in Florida At Concierge Home Care, we are growing and looking for an experienced...

Registered Nurse, RN Majestic Care of Fort Wayne is looking for Registered Nurses to join our team's mission and believe in our core values! Our mission: Through the hearts of our Care Team Members, we provide excellent healthcare to...

We are seeking to hire a Treatment Nurse - Licensed Vocational Nurse to join our team! We are a skilled nursing facility looking for dynamic associates to join our clinical team and provide our residents with a best-in-class care experience.

Job Title Case Manager Company Highmark Inc. Job Description This job is responsible for providing comprehensive case management services to members, ensuring quality, cost-effective care delivery, and...

Benefits: 401(k) Flexible schedule About Us We are a growing, patient-focused Home Health organization dedicated to providing exceptional care in the comfort of patients' homes.

Insight Global is hiring a Spanish-speaking Remote RN Case Manager with a California license to join a healthcare startup redefining how care is delivered for patients with neurological and endocrine conditions. You will build meaningful...

Job Description Responsible for providing utilization review and coordination of care throughout the healthcare continuum to promote quality and cost-effective care to the members. Providence caregivers are not...

A healthcare services provider is seeking a Remote Utilization Review Nurse to coordinate clinical resources, ensuring compliance with healthcare standards. Responsibilities include processing authorizations, reviewing documentation, and...

Senior Director of Nursing Connected & Remote Care (RN) About the Job Senior Director, Nursing - Connected & Remote Care Transform How Nursing Care Is Delivered MedStar Health is seeking a visionary nursing leader to...

Sedgwick is hiring an RN Field Case Manager to support injured workers and coordinate with medical providers from a home-based office. This remote, US-wide role involves frequent travel to facilitate advocacy and timely return-to-work for clients.

Medica is seeking Remote Care Coordinators to manage member care plans and coordinate services across Minnesota communities. This RN-led role emphasizes individualized care, collaboration with providers, and ensuring high-quality member...

Logan Health is hiring a Utilization Management Specialist to join the UM team. The role focuses on reviewing admissions, validating documentation and determining appropriate admission status across the hospital system. You will collaborate...

SCAN is seeking a Medical Management Specialist-RN in California to promote quality and cost-effectiveness of care under regulatory guidelines. You will support utilization management, conduct reviews, and coordinate with the Medical Director for...

You've done UM. You've worked appeals. Now find a role that uses both. We're hiring a contract RN for a New York health plan (Medicare Advantage, Medicaid and MLTC). You'll own clinical grievances and appeals from intake to final decision...

Mass General Brigham is seeking a Preoperative Evaluation RN for remote support with Faulkner Hospital in Jamaica Plain, MA. The part-time position focuses on comprehensive preoperative assessments, patient education, and coordination with...

Centene Management Company LLC is seeking an experienced appeals liaison to manage statewide and external clinical appeals in a remote role. The position requires WA state or compact licensure, with hours Monday through Friday 8:00 am to 5:00 pm...

****Must be located in CA! Will work remote but still attend trainings in LA and need to pick up equipment**** JOB REQUIREMENTS: -Experience: 1 year of CM exp - work comp exp required -CA LVN License -Certs: BLS -**FLU...

Clinical Liaison (RN/Allied Health Professional) Location: Remote (covering PA and NYC) Employment Type: Part-Time - Weekend Coverage 9a-5p Compensation: $55-$60/hr The Role Are you an...

Lvl III Staff RN - Clinic Job Summary: As the leader of the health care team, provides professional nursing care, utilizing the nursing process in accordance with established standards of care, policies, and procedures.

Trauma Nurse St. Francis Medical Center is one of the leading comprehensive healthcare institutions in Los Angeles. St. Francis provides vital healthcare services for the 700,000 adults and 300,000 children in our community who count on...

EOE Statement We are an equal employment opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status or any...

Pride Health is seeking an experienced Registered Nurse (RN) with Utilization Management experience to support clinical quality review and AI model development for prior authorization use cases. The ideal candidate will review records, apply...