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Program Integrity Clinical Compliance AuditorOptum Insight is improving the flow of health data and information to create a more connected system. We remove friction and drive alignment between care providers and payers, and ultimately consumers.

DescriptionYour Role 100% Remote. You will triage calls from our clients in the following manner: 1) assess the needs utilizing injury algorithm guidelines; 2) give appropriate care advice, and 3) disposition to the appropriate...

Licensed Vocational Nurse (LVN) Are you a compassionate Licensed Vocational Nurse (LVN) with a passion for patient care? This is your chance to join a collaborative care team where you'll work closely with physicians and RNs, providing...

Humana is seeking a Behavioral Health Prior Authorization Nurse to join the Wisconsin Medicaid Market (iCare) team. This role involves reviewing the clinical appropriateness of prior authorization requests to ensure they meet medical necessity and...

Schedule: Flexible Shifts! You provide your manager with the days and start/end time you are available to complete your hours. All United States time zones are welcome. PRN opportunity to work 20-30hrs per week Job Location Type:...

NTT DATA is seeking a BPO Clinical Review Specialist in the United States, with remote work available for Florida residents. The role requires an active RN license (Florida or Compact) and at least 3 years of appeals, utilization management, or...

Oregon Department of Corrections is seeking an experienced Institution Registered Nurse for a limited-duration role based in Salem, OR, with remote work options. The RN will review medical records, assess care adequacy, and coordinate services...

Job OverviewPay Range: $46.76hr - $51.76hrRequirement/Must Have5+ years Clinical nursing experience.2+ years Care Management.Bachelor's Degree in Nursing.In lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required...

Job Category: Clinical Services Nursing Requisition Number: CERTI003229 Posted : September 15, 2026 Part-Time On-site Locations Showing 1 location ...

Job Description Location: USC Arcadia Hospital Schedule: Tuesday - Saturday, 12pm - 8:30pm Salary Range: $50 - $55 / Hourly Why Hospice? Why VITAS? Have you ever considered hospice as...

Professional Development Specialist – Care ManagementAt Cedars-Sinai, exceptional care begins with exceptional people. We are seeking a dynamic, collaborative Professional Development Specialist to advance the knowledge, skills, and professional...

MES Solutions is seeking a Clinical Quality Assurance Coordinator (RN/LPN) to review peer reports and ensure accuracy, compliance with client agreements, and regulatory standards. This 100% remote role aligns clinical expertise with quality...

Cambia Health is seeking an Appeals Clinician I to evaluate and finalize clinical appeals across multiple jurisdictions. You will apply nursing judgment and medical policy to ensure compliant decisions, partnering with physicians as needed.

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...

AmeriPharma is seeking an Parenteral Services Clinical RN Specialist to provide expert nursing support for TPN and parenteral therapies. The role emphasizes clinical education, care coordination, and collaboration with nursing, pharmacy, and...

Essentia Health in Duluth, MN is hiring for a Health Services professional to conduct Managed Care Programs in coordination with third party administrators. You will help implement referral, prior authorization, and precertification processes...

Job ID:26-134888 Job Title: Licensed Vocational Nurse Position Type: Full-Time Contract Role Location:Fully Remote Work Type: Work from Home Est. Pay Range: $25.00/Hour to $28.00/Hour on W2 (USD) Schedule: 8-hour shift Monday to Friday anywhere...

Centene Management Company LLC is seeking a Licensed Practical Nurse to analyze prior authorization requests and determine medical necessity in New York. You will work with healthcare providers and the authorization team to ensure timely,...

VHC Health in Arlington, VA is seeking a Virtual Nurse/Nursing Care Partner to provide indirect nursing care to assigned patients across inpatient units via remote technology. The role supports admissions, education and discharge planning with...

OU Health seeks an experienced Utilization Review Nurse (RN) to support the Children's Behavioral Health Center. The role involves evaluating medical necessity, coordinating with Payors, and ensuring appropriate hospital stay authorizations after...

Sentara Health Plans seeks an RN Clinician to perform utilization management and claim reviews across inpatient and outpatient settings. The role supports pre/post payment reviews and authorization assessments, ensuring compliance with policy and...

Requisition Details GENERAL REQUISITION INFORMATION EEO Statement: UNMC is an Equal Employment Opportunity Employer, including an equal opportunity employer of protected veterans and...

Nurse Practitioner Monday through Friday 8 to 5pm, no nights, weekends, or holidays! The Nurse Practitioner provides primary care to enrolled participants by evaluating participant physical complaints and providing appropriate...

Included Health is seeking experienced and mission-driven Nurse Practitioners to support our fast-growing virtual care team. If you're passionate about transforming healthcare and providing high-quality, accessible care to diverse...

NaphCare is hiring a Registered Nurse for the Family and Friends Line (FFL) as part of our Local Government team for our Corporate Office in Birmingham, AL. This position is remote and bilingual capability is required to assist families of...