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Description The UM Denial Nurse Reviewer supports high-quality, cost-effective care by applying clinical knowledge, policies, and regulatory guidelines to the review and processing of adverse organization determinations. This role...

Utilization Management Nurse We are seeking a Utilization Management Nurse to join our team! As a Utilization Management Nurse on the team, you will be responsible for reviewing patient files and treatment methods with an eye for...

Job Opportunity Seeking a compassionate and driven Registered Nurse (RN) Care Manager to join our team in a role designed for nurses who are ready to expand their impact beyond the traditional clinical setting. This position offers the...

Shearwater Health Registered Nurse, Utilization Review At Shearwater Health, we know that better patient outcomes are never achieved alone – especially when there aren't enough hands to deliver care. That's why we've built something...

The Utilization Management Nurse Reviewer plays a crucial role in healthcare systems by ensuring that medical services are used efficiently and appropriately. They review medical records, treatment plans, and patient information to determine the...

Case Manager LVN DaysJoin our team in Los Angeles, CA, as a Case Manager LVN, focusing on patient care coordination and discharge planning.Position Details:Contract: 13 weeks, 40 hours/week, 9am-5:30pm, includes alternating weekendsFloating/On...

Forensic Registered Nurse (RN) Scheduled Weekly Hours: 36 Work Shift: Days/Afternoons (United States of America) Summary of Primary Function The Forensic Registered Nurse (RN) is a highly specialized professional who...

Senior Review Coordinator RN As a Senior Review Coordinator RN, you will be responsible for conducting utilization review/medical management for all services, including training/mentoring other team members, and performing preliminary...

Appeals Nurse The Appeals Nurse examines medical records and claims information for first-level appeal cases to determine whether services provided were medically necessary and meet Medicare coverage guidelines in accordance with Medicare...

Job Responsibilities and Requirements KEY RESPONSIBILITIES *other duties as assigned* Job Summary: Reviews all medical (and other) documentation in claim files to answer the specific...

AvonRisk Utilization Review Nurse AvonRisk is the nation's leading specialty risk manager for self-insured organizations, uniting respected regional leaders in workers' compensation, liability, managed care, and risk management across 32...

Utilization Management Nurse The primary role of the Utilization Management Nurse is to review and monitor members' utilization of health care services with the goal of maintaining high quality cost-effective care. The role includes...

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. We know you've honed your career in a fast-moving...

Overview At Centinela Hospital Medical Center, our dedicated team of professionals are committed to our core values of quality, compassion, and community. As a member of Prime Healthcare, a Top-15 hospital system in the United States, Centinela...

**Job Description****Professional Development Specialist - Care Management****Cedars-Sinai | Integrated Care Management (ICM) & Integrated Service Planning (ISP)****Empower People. Elevate Practice. Make an Impact.**At Cedars-Sinai, exceptional...

THIS IS A REMOTE POSITION Part Time/Contract Position DUTIESAssess patient health problems over the phone and via secure videoSchedule appointments and refer patientsAdvise and monitor simple home...

Nurse Care Manager We're looking for Nurse Care Managers for our Care and Case Management team, who are passionate about caring for members holistically through their healthcare journey and ensuring needs are met with industry-leading...

Assisted Home Health & Hospice is seeking LVNs for shift work in the San Fernando Valley. New grads welcome; training provided. You will deliver in-home nursing care to one patient at a time, in a stress-free environment. Pay is $28/hr with...

Clinical Eligibility & Intake Nurse Part Time/1099 Contractor Fully Remote Monday-Friday; 3-5 hours per day / 15-20 hours per week*; schedule must overlap intake hours** Clinical Operations Reporting to:...

Job Details POSITION SUMMARY RN Case Manager POSITION DUTIES DCP in an acute care setting MINIMUM REQUIRED QUALIFICATIONS 2-3 years' experience in an acute care setting CA license LENGTH OF ASSIGNMENT 13...

JOIN OUR FULLSHIFT STAFFING TEAM!Facility Information:Our facilities are Intermediate Care Facilities for individuals with disabilities (ICF/DD-H and ICF/DD-N)Caregiver (DSP) to people supported ratio is usually...

Home Care Coordinator LVNAlhambra, CAAbout Seen HealthAt Seen Health, we are revolutionizing the way senior care is delivered through the PACE (Programs of All-Inclusive Care for the Elderly) model. Backed by top VCs, Seen Health is a...

Utilization Management Nurse (RN) (Temporary) Remote in California We believe every candidate deserves thoughtful consideration. That's why we do not use AI or automated systems to review applications. Every application is reviewed...

Collaborative Practice Nurse (CPN) Blue Ridge Cancer Care is seeking an experienced and highly motivated Collaborative Practice Nurse (CPN) to support oncology patients across the continuum of care. The CPN serves as a clinical resource...

Collaborative Practice Nurse (CPN) Blue Ridge Cancer Care is seeking an experienced and highly motivated Collaborative Practice Nurse (CPN) to support oncology patients across the continuum of care. The CPN serves as a clinical resource...