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JOB DESCRIPTION Job SummaryProvides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and...

The RN Coordinator Utilization Management to review submitted authorization requests for medical necessity, appropriateness of care and benefit eligibility. This position reviews applicable guidelines regarding payment and coverage, and makes...

CVS Health Job Opportunity 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 colleagues who care...

Travel RN Case Manager Assignment length- 13 weeks Near Los Angeles Area Our Client is a nonprofit, independent healthcare organization committed to improving the health status of the...

Nurse Case Management Senior Analyst Pay rate max is ***/hour or following your Client rate card. This is a remote position in any state except, NY, CA, HI, or AK. This role is 8am-5pm M-F. Manager prefers compact RN license. Nurse Case...

To support healthcare revenue solutions, the full-time Remote Clinical Review Nurse will analyze denied insurance claims, draft persuasive appeal letters, and collaborate with legal teams to optimize patient care revenue without direct patient...

Company : Highmark Inc. Job Description : JOB SUMMARY This job has primary ownership and oversight over a specified panel of members that range in health status/severity...

Grievances And Appeals Nurse Pride Health is hiring a Grievances and Appeals Nurse for a well-known client! (Remote Contract) Schedule: 5x8s Day shift Contract: 6 months Pay Rate: 40-45/hr Primary...

Per Diem Care Manager, RN Optum is a global organization that delivers care, aided by technology, to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people...

DescriptionJoin a world-class healthcare organization and play a key leadership role in delivering high-quality, patient-centered care. UCLA Health is seeking a dynamic and experienced Utilization Management Assistant Director to oversee Intensive...

RN Clinical Manager / Clinical Consultant (RN or MSW) – California Pay Rate: $52.50–$53.00/hr Position Type: Special Projects – 12-Month W2 Contract (renewal based on performance, project continuation, and health plan needs)...

Registered Nurse-Case Manager Job ID #2015247 | Share About this Role In your role as Case Manager, you can be the connection between exceptional care and the positive effect it has on every...

Job Title Utilizes a collaborative review process of benefits, minimally necessary clinical information and evidence-based clinical guidelines to formulate decisions regarding medical necessity, pre-existing conditions, benefits and/or...

At Habitat Health, we envision a world where older adults experience an independent and joyful aging journey in the comfort of their homes, enabled by access to comprehensive health care. Habitat Health provides personalized, coordinated clinical...

Clinical Denial Management Nurse Work remotely with a collaborative enterprise denials team focused on reimbursement accuracy and revenue recovery. Work Style: Remote Location Requirement: Must reside in an authorized state (FL,...

Case Manager RNLocation: Mission Hills, CAEstimated pay: $2289 weekly gross (does not include taxes, insurance, or other deductions)Start date: 6/8/2026Shift: 8H Days (8:00 AM-4:30 PM)Length: 13 weeksWeekly hours: 40Facility type: Short Term Acute...

Overview:Our client, a mutual benefit corporation and health plan provider, seeks an accomplished Appeals and Grievance RN .*** Candidate must be authorized to work in USA without requiring sponsorship...

Horizon Blue Cross Blue Shield of New Jersey empowers our members to achieve their best health. For over 90 years, we have been New Jersey's health solutions leader driving innovations that improve health care quality, affordability,...

Valeris is a fully integrated life sciences commercialization partner that provides comprehensive solutions that span the entire healthcare value chain. Formed by the merger of PharmaCord and Mercalis, Valeris™ revolutionizes the path from life...

Description Location: UCHealth Anschutz Outpatient Pavilion - Aurora, CO Department: Hospital Based Sub-Specialty Work Schedule: Full Time, 80.00 hours per pay period (2 weeks) Shift: Days Pay: $38.91 - $60.31 / hour. Pay is dependent on...

Grievance & Appeals Nurse Specialist Join Us in this Amazing Opportunity We are a mission driven community-based organization that serves member health with excellence and dignity, respecting the value and needs of each person. If...

DRG Nurse Reviewer Appeals and Hearings- Remote It takes great medical minds to create powerful solutions that solve some of healthcare's most complex challenges. Join us and put your expertise to work in ways you never imagined possible.

Discharge Care Manager Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with...

Description Manages specific patients throughout their admission to ensure the availability of sufficient clinical and medical center resources. Communicates on a daily basis with medical staff, medical center personnel and...

Join Martin's Point Health Care - an innovative, not-for-profit health care organization offering care and coverage to the people of Maine and beyond. As a joined force of "people caring for people," Martin's Point employees are on a mission to...