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Piper Companies is seeking a Clinical Appeals Nurse to join a leading health insurance organization for a contract remote opportunity located in North Carolina. The Clinical Appeals Nurse will serve as a clinical...

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...

Our client, a mutual benefit corporation and health plan provider, seeks an accomplished Registered Nurse (Utilization Management). *** Candidate must be authorized to work in USA without requiring sponsorship...

Comagine Health in Alabama is seeking Clinical Utilization Review Nurses (RN) to assess medical necessity and quality of care through prospective, concurrent, and retrospective utilization reviews. This is a full-time remote role supporting...

Get AI-powered advice on this job and more exclusive features. This range is provided by The Judge Group. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more. Base pay range...

Medical Review Nurse III Fully Remote • Windsor Mill, MD Overview Salary Range $80,000.00 - $95,000.00 Salary Position Type Full Time Education Level 4 Year Degree Description At RELI Group, our work is...

Job Description Join a team that's shaping the future of pediatric care. Children's Hospital Los Angeles is consistently ranked among the top 10 children's hospitals in the nation, delivering world-class care through more than 350...

Make written and oral reports/recommendations to the attending physician, Medical Director, or the DON concerning the status and care of the residents. • Agree not to disclose resident's protected health information and promptly report...

CVS Health is seeking a Nurse Consultant for Utilization Management in a 100% remote capacity. The role reviews inpatient and outpatient services using evidence-based criteria, authorizes care with providers, and escalates cases as needed.

Compliance Nurse Trillium Health Resources is a Tailored Plan and Managed Care Organization (MCO) serving 46 counties across North Carolina. We manage services for individuals with serious mental health needs, substance use disorders,...

Utilization Review Nurse Join our team at Cobalt Benefits Group and start an exciting new career in employee benefits solutions. As a Utilization Review Nurse, you'll play an important role in helping us offer customized, self-funded...

Registered Nurse Dialogue is the #1 virtual care provider in Canada. By developing our Integrated Health Platform, we provide exceptional online health and wellness programs to organizations that want to improve the wellness of their...

This RN will act as a Care Manager supporting our Michigan Medicaid members, identified with complex medical needs. The Medicaid Care Manager will support them to ensure a successful health outcomes. The position includes telephonic...

Iris Telehealth is hiring PMHNPs for 100% remote consult-liaison telepsychiatry in Texas. Earn $120/hr with a sign-on bonus, working 13–16 overnight shifts per month, including weekends. Roles require Texas PMHNP licensure, 2 years...

Resp & Qualifications We are looking for an experienced professional to work remotely from within the greater Baltimore metropolitan area. The incumbent will be expected to come into a CareFirst location periodically for...

At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers. Join HCSC and be part of a...

RN Case Manager Qualifications for RN Case Manager: The Case Manager is responsible for managing a continuum of care from admission through discharge for assigned patients. Partners with medical staff, utilizes scientific evidence...

Comagine Health seeks a Consultant to support our Health System Improvement team, with a focus on Long Term Care Facilities. This on-call role provides expert guidance across clinical, operational, public health, and quality improvement domains to...

Beth Israel Lahey Health is seeking a Per Diem PAT Nurse for Milton Hospital. The role, initially on-site for orientation, moves to a fully remote schedule with flexible shifts. You will perform pre-admission assessments and coordinate...

JOB DESCRIPTION We are searching for six TX licensed RNs to work telephonically with our Medicaid members across the state. Three of the positions are open to RNs with at least two years of experience in in Behavioral Health or Substance...

Oscar Health is seeking a Utilization Review Nurse to join our team. You will review cases, verify medical records, and consult with care providers to assess treatment appropriateness using Oscar Clinical Guidelines, MCG, and InterQual. The...

Delegation Oversight Nurse Auditor If you are as passionate about helping those in need as you are about growing your career, consider AltaMed. At AltaMed, your passion for helping others isn't just welcomed – it's nurtured, celebrated,...

SCAN Health Plan seeks a HEDIS Nurse to review medical records and support NCQA-driven quality initiatives. This remote role coordinates with members and providers to collect complete data, focusing on medication adherence and preventive...

Nurse Consultant II (NS) The North Carolina Department of Health and Human Services (DHHS) is one of the largest, most complex agencies in the state, and has approximately 17,000 employees. It is responsible for ensuring the health,...

Utilization Management Nurse Consultant (RN) We're building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you'll be surrounded by passionate...