- CVS Health (Santa Fe, NM)
- …healthcare for members. **Position Summary** We are seeking a dedicated Utilization Management (UM) Nurse to join our remote team. In this role, you'll be at ... shifts: 9:00am-5:30pm, 9:30am-6:00pm, 10:00am-6:30pm, or 11:30am-8:00pm EST Hours) Location: 100% Remote (US only) **About us** American Health Holding, Inc. (AHH),… more
- ManpowerGroup (Austin, TX)
- …partnership team supporting Medicaid services in Texas. This is a non-clinical, ** remote ** - review role focused on **prior authorization** and **utilization ... about improving patient outcomes through smart, resource-conscious care decisions. **Location:** Remote , but near Austin, TX **Schedule:** Full-time | Must be… more
- Cedars-Sinai (CA)
- …a condition of continued employment. **Req ID** : 11005 **Working Title** : Registered Nurse - Lung Transplant Coordinator - Remote ON CALL **Department** : Lung ... happy to hear from you. With expert surgical and medical proficiency in lung, heart, liver, kidney, and pancreas...hope for a longer, healthier life. **This is a remote on-call position with a 24-hour shift schedule (7:00am… more
- Prime Therapeutics (Atlanta, GA)
- …passion and drives every decision we make. **Job Posting Title** Infusion Referral Nurse Sr- REMOTE **Job Description** Under supervision, is responsible for ... Nursing + Bachelors - Nursing + RN - Registered Nurse , State and/or Compact State Licensure - Care Mgmt...in managed care, specialty drugs, care management and utilization review . + Meets Credentialing criteria. + At minimum must… more
- 315 health (Warner Robins, GA)
- …confidence in navigating their healthcare. We are looking for a qualified Registered Nurse (RN) to serve our patient population in the navigation, prevention and ... management of their health through continuous care programs like Remote Patient Monitoring and Chronic Care Management. Our team works fervently to anticipate the… more
- Molina Healthcare (Warren, MI)
- …on set schedule) Looking for a RN with experience with appeals, claims review , and medical coding. **Job Summary** Utilizing clinical knowledge and experience, ... that has a current active unrestricted license This a remote role and can sit anywhere within the United...responsible for review of documentation to ensure medical necessity… more
- CVS Health (Oklahoma City, OK)
- …do it all with heart, each and every day. **Position Summary** This is a **fully remote role** with a requirement to **reside in Oklahoma** . The nurse in this ... of healthcare services and benefit utilization. This position requires close review of both handwritten and digital documents, and involves extended periods… more
- US Tech Solutions (Columbia, SC)
- …if it can be reviewed at our level. If not, then it would be sent for review with our medical director. We would then complete the approval or denial and notify ... - 5pm. + Onsite training for the first week. Remote once training is complete. + A typical day...resources to promote quality, cost effective outcomes. + Performs medical or behavioral review /authorization process. Ensures coverage… more
- Datavant (Washington, DC)
- …+ 3+ years of CDI experience + 3+ years of clinical experience in an academic medical center + Registered Nurse license, Bachelor's degree in Nursing + CCDS or ... you will play a pivotal role in elevating the impact of our medical record documentation. You will conduct daily evaluations and engage in direct communication… more
- Actalent (Tigard, OR)
- Job Title: Clinical Review Nurse - Concurrent Review (West Coast) Job Description We are seeking a dedicated Clinical Review Nurse to perform ... health of members, reviewing the type of care being delivered, evaluating medical necessity, and contributing to discharge planning according to care policies and… more