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American Health Plans Franklin, TN 37067, USA Description American Health Plans, a division of Franklin, Tennessee-based American Health Partners Inc. owns and operates Institutional Special Needs Plans (I-SNPs) for...

Alignment Health is seeking an inpatient review nurse to join our remote utilization management team. The nurse will collaborate with the patient's PCP, facility case manager, discharge planner, and contracted providers to ensure appropriate,...

TEEMA Group is seeking a Clinical Quality Reviewer (RN or LCSW) for remote work in approved states. This role focuses on reviewing clinical cases, identifying quality or safety concerns, and supporting quality improvement initiatives across a...

Southcoast Health seeks a Team Lead-Centralized Clinic Support to join a remote role serving MA/RI communities. The role guides nursing staff, ensures clinical workflow compliance, and drives care coordination and patient safety across ambulatory...

UnitedHealth Group is seeking a SSBV Clinical Claims Review RN for a remote role nationwide. You will perform administrative reviews of inpatient hospital claims, document determinations, and ensure accurate use of screening criteria to support...

Salary : $107,352.48 - $160,692.96 Annually Location : Los Angeles County, CA Job Type: Full time Job Number: PH5230H Department: PUBLIC HEALTH...

Alignment Health is seeking an inpatient review nurse to join the remote utilization management team. You will assist patients through the continuum of care in collaboration with the patient's primary care physician, facility case manager,...

Job Summary and Responsibilities As a Clinic Registered Nurse (RN), you will be a central figure in our patient care team, delivering exceptional, compassionate care that truly makes a difference in our patients'...

Central Intake Nurse Job Type: Full-Time Remote possible Benefits Offered: Healthcare Dental Vision PTO 401K Your Job Summary The Central Intake Nurse...

State of North Carolina - Health & Human Services in North Carolina seeks a Nurse Consultant I who conducts regulatory nursing home inspections to ensure compliance with federal and state standards. The role involves travel across Central and...

Job Summary: Provides consultation and leadership in designated areas of expertise with minimal oversight. Collaborates with interdisciplinary teams and stakeholders to address issues and achieve project objectives. Shares knowledge and best...

We are seeking to hire an IP 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! Whether you are just starting your...

Insurance Or Managed Care Industry Registered Nurse (RN) $40/hour - Contract for 6 months Must reside in TX Full time remote Candidates must be based in TX. RN working in the insurance or managed care industry using medically...

To support client care authorization processes, the part-time Temp Clinical Letter Writer will gather and review medical records, draft letters of medical necessity, and communicate with team members regarding client authorizations and...

About the Job ASSIGNMENT SUMMARY: The Registered Nurse (RN) will be responsible for coordinating, implementing and supervising all nursing and personal care services at the Adult Day Health Care Center. The...

Brighton Health Plan Solutions is seeking an experienced Utilization Management Nurse to perform medical necessity and benefit reviews remotely, supporting both inpatient and outpatient cases. The role requires an active LPN license, strong...

Position Type: Student Support Services/School Nurse Date Posted: 10/16/2026 Location: Administration Building Date Available: 2026-27 School...

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...

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...

Job Summary: We seek a highly skilled and experienced Registered Nurse with specialties in Medical/Surgical, ICU, ER, Psychiatric, Labor & Delivery, PACU, or Operating Room to perform utilization review duties. The Registered...

Highpoint Health Sumner is seeking a Registered Nurse (RN) Clinical Documentation Specialist to join as a remote FT (days). You'll contribute by applying plan-of-care interventions and driving patient-care innovations with advanced technology.

Job Description Registered Nurse (RN) -Los Angeles,CA Local Pay: $56.75/hour (W2) Join our team and make a meaningful impact by delivering exceptional...

Job Title This is a remote, PRN position but will need onsite training in Mishawaka Indiana. Shift: Days - 8 hr shift LOCAL CANDIDATES ONLY! Why Choose Saint Joseph Health System? At Saint Joseph Health System, our values...

Amerit Consulting is seeking an experienced Utilization Management Nurse (RN) in California for a remote 6-month contract. The incumbent will support inpatient utilization review, medical necessity determinations, and facility claims compliance,...

Alignment Health is seeking an inpatient review nurse to join the remote utilization management team. The role focuses on reviewing inpatients with complex medical needs, coordinating with PCPs, facilities, and community resources to ensure...