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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...

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GQR Healthcare is seeking a travel nurse Correctional for a travel nursing job in Commerce, California. Job Description & RequirementsSpecialty:...

A leading healthcare provider is seeking a Registered Nurse for their LTSS department in New York. This role involves providing case management services, evaluating medical services, and managing appeals for denied services. Candidates must...

HealthEdge in the United States seeks a Telephonic Utilization Management RN for Behavioral Health to coordinate care and perform medical necessity reviews across inpatient, outpatient, and ancillary services. Coordinate care through the health...

Medlogix, LLC in Hamilton, NJ seeks a Quality Assurance Nurse for a hybrid role, combining remote work with occasional in-office days. The position involves reviewing IME and peer review reports, ensuring accuracy, consistency, and adherence to...

Trillium Health Resources is seeking a Population Health Nurse to provide clinical care management and population health support for assigned members, focusing on prevention, wellness, and outcomes. The role uses nursing judgment as an RN to...

Concierge Home Care | Remote Opportunity | Growth Opportunities | Increased Earning Potential At Concierge Home Care, we are growing and looking for an experienced Utilization Review Specialist (RN) to join our remote home health...

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...

Masimo is seeking a Clinical Research Lab RN to join our team in Irvine, CA. You will perform venous sampling, IV placement, and arterial-line tasks while supporting R&D funding, regulatory filings, and marketing initiatives for Masimo products.

CVS Health is seeking a Nurse Consultant for a 100% remote role. You will apply clinical judgment and evidence-based criteria to review inpatient and outpatient services, authorize care, and escalate cases as needed, while coordinating with...

Montefiore St. Luke's Cornwall is seeking a Clinical Documentation Integrity Specialist (CDIS) to improve the quality and completeness of clinical documentation. You will work with physicians and clinicians to ensure documentation reflects the...

HealthEdge Software, Inc. is seeking a highly motivated Utilization Review RN to join our team. The RN will perform prospective, concurrent and retrospective reviews of inpatient, outpatient, and ancillary services to ensure medical...

Fire Department Nurse Educator, Per Diem – Emergency MedicineWork Location: Los Angeles, CAJob #: 28350Work Hours: Varies depending on departmental needsEmployment Type: 6 – Staff- Per DiemDuration: IndefiniteSalary Range: $34.6-70.91...

Performance Home Health is seeking an experienced Referral Review Nurse to join our growing team. This role reviews incoming home health referrals, ensures complete documentation, identifies missing information, and coordinates with multiple...

Managed Medical Review Organization seeks a licensed RN for a home-office, remote role focused on telephonic customer service and clinical documentation. The position emphasizes quality review, case management, and adherence to policy, with...

Centene is seeking a remote Utilization Review Nurse to perform concurrent reviews, determine appropriate levels of care, and support discharge planning for inpatient services. You will collaborate with Medical Affairs and care teams to ensure...

Care Career is seeking a travel nurse RN Labor and Delivery for a travel nursing job in Los Angeles, California. Job Description & RequirementsSpecialty: Labor and...

Novitas Solutions, Inc. seeks a Clinical Review Nurse to review and substantiate medical determinations for health claims. You will assess medical necessity, service levels, and appropriateness of care under national and local policies,...

Army Public Health Nurse Job Overview As an Army Public Health Nurse, you'll assess health risks and implement programs to monitor the spread of disease. You'll promote wellness for Soldiers and their families while also informing policy and...

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...

Inland Empire Health Plan in California seeks an LVN-validated Claims Review Nurse to audit medical necessity across inpatient and outpatient claims and support the UM/Claims interface. You will analyze records, determine authorization needs, and...

About the opportunity: Vail Health has become the world's most advanced mountain healthcare system. Vail Health consists of an updated 520,000-square-foot, 56-bed hospital. This state-of-the-art facility provides exceptional care to all of...

Spectrumforce Technologies, Inc. is seeking a Clinical Review Nurse - Concurrent Review for a 3-month contract to hire. The role is remote with work location listed as Remote-MS CST, schedule 8 am-5 pm Central time, with occasional weekend...

Effizotech is looking for a dedicated Patient Care Coordinator to join their team. This role involves coordinating patient appointments for infusion services while ensuring timely communication with patients. The opportunity offers the flexibility...