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Quality Correctional Care Quality Correctional Care (QCC) is a mission-driven organization that provides medical and mental healthcare and addiction recovery services to justice-involved patients. Our approach to patient care is uniquely...

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...

UCLA Health Advanced Practice Nurse Work Location: Santa Monica, CA, USA Work Schedule 4-day 10-hour shifts, 7:00am-5:30pm; may include weekends and holidays Salary Range: $68.81 - 88.99 Hourly Employment Type 2 - Staff:...

License Vocational Nurse Are you looking for a new job? My name is Caroline and I'm a healthcare recruiter – I'm here to help! I'm working with an amazing private practice outpatient treatment and infusion center. This is a dynamic,...

Munson Healthcare is seeking a remote Front Desk Clerk to greet patients and families and manage registrations. Responsibilities include collecting insurance information, scheduling appointments, and coordinating with care teams. Remote...

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...

To support staffing needs for patients, the part-time Ohio Licensed LPN Scheduler will manage clinical support and staffing duties, ensuring accurate order reviews while working remotely after training.Key responsibilitiesAssign and staff all...

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...

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...

Centene Corporation seeks an experienced RN to analyze prior authorization requests from a remote location within the United States. The role evaluates medical necessity and appropriate level of care in line with national standards and contract...

Details Client Name Cedars-Sinai Medical Center - Los Angeles Job Type Travel Offering Nursing Profession RN...

Vynca Inc. is seeking a Clinical Intake Specialist to join the ECM care management team. This role works with clients to determine needs and connects them to the right resources, reviewing medical charts and supporting person-centered care.

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...

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,...

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...

Telligen is seeking a Senior Review Coordinator RN to conduct utilization review and medical management for all services, including mentoring teammates and performing preliminary research. This is a home-based, part-time role with Saturday and...

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...

RN Career Transition Opportunity – Nurse Case Manager Are you an RN seeking a rewarding career shift that uses your clinical skills and compassion — without the physical demands of bedside care? QuestPro has the exclusive...

Licensed Vocational Nurse (Subacute/Full Time/Days)Performs under the supervision of a licensed nurse, carries out the established plan of care for an assigned group of patients. Uses observation, planning, and implementation skills to ensure the...

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...

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...

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.

Job Summary: Provides comprehensive nursing care to patients in an outpatient setting, ensuring safety, quality, and compassionate treatment. Supervises nursing staff, coordinates with multidisciplinary teams, and supports patient education and...

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...

Position Summary The RN Case Manager is responsible for performing clinical assessment and reassessment of acute care Inpatients for the purpose of performing utilization review, resource management and safe discharge...