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Overview The Care Management Recovery Advocate (CMRA) is responsible for providing overall management and communication of clinically-based appeals between Providence Health and Services, California Region (PH&S) outside payers.

A leading healthcare provider in Virginia is seeking a Registered Nurse Case Manager (RN) to join the team. The role is full-time, focusing on patient discharge planning, data analysis for care continuity, and collaboration with healthcare...

A workforce solutions company is seeking a Registered Nurse-Case Review Specialist to provide support for Federal Occupational Health. This remote position requires extensive nursing experience and strong communication skills to ensure timely...

Part-Time Utilization Review Nurse Remote (Nevada License Required) Location: Remote (Reporting to Carson City, NV) Schedule: MondayFriday, 8:00 AM12:00 PM PST Compensation: $40,000$45,000 annually (part-time, 20 hours/week)...

A healthcare provider is seeking a Utilization Management Clinical Manager for analyzing medical service requests. The ideal candidate will possess an RN license and extensive experience in prior authorization in managed care. Responsibilities...

Description Location: UCHealth Anschutz Inpatient Pavilion - Aurora Department: Virtual Health Center - Quality program This position is an onsite role and does not offer a hybrid or remote option Work Schedule: Full Time, 72.00 hours per pay...

A healthcare management firm is seeking a detail-oriented Utilization Management Reviewer for a fully remote position. The role includes reviewing care based on evidence-based guidelines, ensuring quality and compliance while upholding medical...

Telephonic Case Manager At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation's leading health solutions...

As members of the Optum family of businesses, we are dedicated to helping people feel their best, including our team members who create meaningful connections with patients, their families, each other and the communities we serve. Find a home for...

Description Location: UCHealth Anschutz Inpatient Pavilion - Aurora Department: Virtual Health Center - Quality program This position is an onsite role and does not offer a hybrid or remote option Work Schedule: Full Time, 72.00 hours per pay...

A leading healthcare organization in California is seeking a Registered Nurse, Out-Patient Case Manager. This role involves coordinating care for patients with chronic diseases and leading a team of case managers. Candidates should have a valid RN...

Job Summary The RN Clinical Appeals Nurse provides support for internal appeals clinical processes - ensuring that appeals requests are reevaluated in alignment with applicable federal and state regulatory requirements, Molina policies...

Quality Assurance Position Contract-to-hire details and pay: $34/hr for a 520-hour contract-to-hire, long term opportunity. Compensation: listed below, fixed rates (no opportunity for negotiation). Training schedule: MondayFriday, 46...

Clinical Documentation Improvement (CDI) Specialist Registered Nurse (RN) 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...

Job Summary The RN Clinical Appeals Nurse provides support for internal appeals clinical processes - ensuring that appeals requests are reevaluated in alignment with applicable federal and state regulatory requirements, Molina policies...

Amergis Healthcare Staffing, Inc. is seeking a travel nurse RN Outpatient Telehealth for a travel nursing job in Portland, Oregon. Job Description & Requirements Specialty: Telehealth Discipline: RN Duration: 13 weeks 40 hours per week Shift: 8...

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation's leading health solutions company, we reach millions...

Location: REMOTE - Must Work EST ( Required: NC license or Compact license ) SHIFT: Monday-Friday 8 am-5pm EST; No OT expectations Duration: 1 year (Possible contract to Hire) Job Description: Process authorization requests for TP product, will...

The RN Case Manager is responsible for coordinating continuum of care activities for assigned patients and ensuring optimum utilization of resources, service delivery, and compliance with medical regime. Minimum...

A healthcare organization in Manchester, NH, seeks a Nursing professional to provide centralized medication access support. Responsibilities include reviewing medication requests, communicating with patients, and adhering to clinical guidelines.

Weekend Hospice Triage Nurse - Remote - Must Have Ca Rn License By The Bay Health, a non-profit established in 1975, set the standard for hospice in the U.S. by emphasizing the role of the patient in making important medical decisions.

A leading healthcare provider is seeking an RN Concierge Care Manager to deliver case management for high-risk patients remotely. The role involves high-touch management, coordinating care across specialized programs and requires an active RN...

Job Summary The RN Clinical Appeals Nurse provides support for internal appeals clinical processes - ensuring that appeals requests are reevaluated in alignment with applicable federal and state regulatory requirements, Molina policies...

About this job Using your knowledge and experience, you'll be working directly in your area of care. Prepare to hit the ground running with a great attitude and let your professional skills shine! Duties &...

Job Summary The RN Clinical Appeals Nurse provides support for internal appeals clinical processes - ensuring that appeals requests are reevaluated in alignment with applicable federal and state regulatory requirements, Molina policies...