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Baptist Health is seeking a Clinical Documentation Specialist to join our team. This remote position requires residence in Kentucky or Indiana and focuses on evaluating physician documentation to ensure severity of illness is accurately portrayed...

SCAN is seeking an HEDIS Nurse to review medical records for Quality Initiatives/NCQA reporting. The role involves outreach to members and providers to ensure complete data and adherence to NCQA guidelines, with a focus on medication adherence and...

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...

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...

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

Spectraforce is seeking a Remote Medical Reviewer focused on post-market medical devices. The role requires an active RN license and 2–3 years of clinical nursing experience, with a strong emphasis on regulatory knowledge and independent...

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,...

Clinical Research Nurse I Locations: Los Angeles, California Job Category: Registered Nurse Position Type: Full-Time Shift: Days Job Description Join a team that's...

Comagine Health in Washington State is seeking an experienced Registered Nurse to join our remote Clinical Reviewer team. The role focuses on assessing medical necessity, appropriateness, and quality of care through prospective, concurrent, and...

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...

Palmetto GBA, LLC, a BlueCross BlueShield subsidiary, seeks an RN reviewer to conduct medical claim reviews from a home office. You will assess medical necessity and ensure adherence to established criteria, while supporting staff with guidance...

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...

Elevance Health is seeking a HEDIS Medical Record Review Project Nurse to support HEDIS data abstraction and quality review in a fully virtual role with occasional in-person training. The position requires residing in Florida, a BSN, and at least...

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...

Capitol Bridge LLC is seeking a Claims Review Nurse to support the Florida Statewide Health Plan CDR program and other state IRO programs. The role involves assessing documentation, coordinating with clinical reviewers, and drafting determinations...

Performance Home Health is seeking an experienced, detail-oriented Quality Assurance Registered Nurse to join our growing team. This is a fully remote position; however, candidates MUST reside in Texas to be considered. In this role, you...

Carenet Health is hiring registered nurses for fast-paced telehealth triage and patient education roles. You will work from home across the United States, delivering care and guidance via phone, video, or chat while maintaining high clinical...

Providence Tarzana Medical Center in Tarzana, CA is seeking a Certified Nursing Assistant for the Cardiovascular Unit. This Full-Time role requires CA Nursing Assistant Certification, BLS, and completion of the Nursing Assistant course, with...

CSI Pharmacy, LLC seeks a Regulatory and Compliance Nurse to implement and maintain the nursing employee health program across states, ensuring TB screening, immunization tracking, disease monitoring, and recordkeeping meet regulatory standards.

Centene Corporation in the United States is seeking a Nursing professional to analyze prior authorization requests and determine medical necessity and level of care in line with standards and coverage. You will collaborate with medical teams to...

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,...

Bestica is seeking a travel nurse RN Research / Clinical Research for a travel nursing job in Fullerton, California. Job Description & RequirementsSpecialty: Research /...

MedWatch LLC is seeking a Remote Utilization Review Coordinator licensed practical nurse (LPN) to perform review and certification duties. The role requires an unrestricted LPN license and at least three years of clinical nursing experience.

Note : This is an educational program, not a job. Successful completion of the program does not guarantee employment but will equip you with valuable skills for the healthcare job market. Looking to start a rewarding career path in the...

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...