The Case Management Utilization Review Registered Nurse at Steward Health Care is responsible for documenting medical necessity for inpatient status or placement in observation, communicating with physicians and clinicians, and ensuring timely clinical information is sent to payors for authorization. This role involves coordinating with allied health professionals to ensure quality care and outcomes, developing physician profiles for utilization patterns, and optimizing inpatient length of stay and resource utilization.

Case Management Utilization Review RN - REMOTE - Utilization Review

Case Management Utilization Review Registered Nurse

Cambia Health Solutions, Inc is seeking a Care Management Nurse to join their team, offering a work from home opportunity within Oregon, Washington, Idaho, or Utah. This role involves providing clinical care management, including case management, disease management, and care coordination, to meet members' healthcare needs and promote quality and cost-effective outcomes. The position is part of a candidate pool for future opportunities, allowing candidates to be considered for all suitable positions as they become available.

Remote Care Management Nurse (Future Opportunities)

Care Management Nurse

We are seeking a Nurse Practitioner or Physician Assistant to perform medical assessments on United States Veterans as part of the VA's disability benefits process. The role involves reviewing medical records electronically, performing focused, in-person physical exams, and documenting findings through a web portal. The position does not involve treating or prescribing medication, as the VA makes all disability determinations.

Nurse Practitioner - Physician Assistant - Sierra Vista AZ

Nurse Practitioner or Physician Assistant

The Licensed Practical Nurse (LPN) role at US Tech Solutions, Inc. involves performing medical reviews using established criteria sets, ensuring medical services are within benefit and medical necessity guidelines, and providing education to members and their families. This fully remote position requires strong computer skills, a diverse background in home health or DME, and the ability to work independently after an initial onsite training period. The role is contract-based for 5+ months, with a typical workday of 8:00-4:30 Monday to Friday.

Licensed Practical Nurse (LPN)

Licensed Practical Nurse

Wellpath is hosting a Virtual Hiring Event for Registered Nurses (RN) and Licensed Practical Nurses (LPN) in Fayetteville. This event offers an opportunity to learn more about the company, its benefits, and to apply for positions. The event is designed to make it easy for interested candidates to connect with the recruiter and potentially start their career with Wellpath.

Virtual Hiring Event for RN's & LPN's - Fayetteville

Registered Nurse

IntellaTriage is seeking part-time Hospice Triage Registered Nurses to join their team, offering a remote work setting with a focus on end-of-life care. Nurses will provide compassionate care through nurse triage, utilizing high-speed internet and tech-savvy skills. The role involves working a minimum of one evening shift weekly, every other weekend, and may include additional shifts as needed. Training is provided remotely, and nurses will use their own laptop and high-speed internet for work.

Remote Hospice Triage RN- PT 1 shift 6p-12a+ rotating Sat & Sun

Hospice Triage Registered Nurse

The Registered Nurse for PreCert and Appeals at ProMedica Health System performs prior authorization/certification of scheduled services with payers and assists with the appeal process when needed. This role involves clinical review and document submission for oncology treatments plans and services, interfacing with payers on plan medical coverage policies, and managing denial reports. The position is remote, ideally within 120 miles of Toledo, OH, and requires a nursing degree, 2 years of clinical experience, and familiarity with ICD10 and CPT codes.

RN / Registered Nurse - PreCert and Appeals - Remote - Per Diem - Days

Registered Nurse - PreCert and Appeals

Nemours Children's Health is seeking an experienced pediatric telephone triage nurse to support our primary care practices in Delaware, Pennsylvania, and Florida. This casual (8 hours/week), fully remote position involves self-scheduling, including one shift every other weekend and two holidays per year. The role includes providing primary care patients with telephone access to a registered nurse for medical concerns during office hours, escalating to the on-call physician when necessary, and ensuring continuity of care through communication with the health team.

Telephone Triage Nurse (Casual) - Telehealth

Telephone Triage Nurse

Children's Health (Dallas) is seeking a Registered Nurse (RN) Float Virtual Care for a nursing job in Plano, Texas. This role involves providing guidance and support to registered nurses working in direct patient care at CMC Plano from a remote work setting. The RN utilizes the nursing process to support nurses, completes chart audits, and collaborates with healthcare professionals to ensure comprehensive care. This position is part of a Pilot Program and will be evaluated for continuation, adjustment, or discontinuation after a predetermined period.

STAFF - REGISTERED NURSE (RN) - FLOAT VIRTUAL CARE - $23+ PER HOUR

Registered Nurse - Float Virtual Care

The Traveling Registered Nurse at Solutions by Sanford is responsible for utilizing the nursing process to provide individualized nursing care to residents. This role involves collaboration with residents, families, and interdisciplinary colleagues to plan, implement, and evaluate care. The nurse will work at various Good Samaritan Society sites within the assigned area, with contracts ranging from 6 to 13 weeks, offering the option to extend or move to another site. This position requires at least two years of experience, including one year of travel experience, and offers weekly pay with a stipend, eligibility for Sanford Benefits, and the opportunity to work remotely in ND.

TRAVELING REGISTERED NURSE

Traveling Registered Nurse

AmeriHealth Caritas is seeking a Care Manager II Registered Nurse for their Foster Care Program in South Carolina. This remote position requires a BSN and an unrestricted RN license in South Carolina or a compact state. The role involves engaging directly with members through face-to-face visits in the community, monitoring and updating care plans, and collaborating with healthcare professionals to ensure members receive comprehensive care. The ideal candidate will have experience in pediatric home care or acute care, and preferably in the Foster Care System, Department of Social Services, or Department of Juvenile Justice.

REMOTE | CARE MANAGER II REGISTERED NURSE (BSN) - FOSTER CARE PROGRAM -SC

Care Manager II Registered Nurse

The Registered Nurse - Review Analyst at W3R Consulting will perform prospective, concurrent, and retrospective review of inpatient, outpatient, ambulatory, and ancillary services to ensure medical necessity, appropriate length of stay, intensity of service, and level of care, including appeal requests initiated by providers, facilities, and members. This role may also involve establishing care plans and coordinating care through the healthcare continuum, including member outreach assessments.

Registered Nurse - Review Analyst

The Clinical Triage Nurse at Sutter Health aids patients in obtaining the correct level of care with the appropriate provider at the right time. This role involves providing advance clinical telephone support to patients, other callers, in-basket and other remote support for physicians, and limited in-clinic support. The nurse uses the nursing process, input from physicians, and Sutter Health's approved telephone nursing guidelines and protocols to maintain highly efficient operations, provide quality care, and ensure positive patient outcomes. Responsibilities include assessing patients' needs, appropriately disposing of cases, collaborating with clinic and hospital-based providers, and performing nursing follow-up activities.

Clinical Triage Nurse - Work From Home

Clinical Triage Nurse

Trusted Resource Associates (TRA) is seeking a local contract nurse RN Utilization Review for a local contract nursing job in Modesto, California. The RN Case Manager is responsible for facilitating care along a continuum through effective resource coordination to help patients achieve optimal health, access to care, and appropriate utilization of resources, balanced with the patient's resources. This position involves managing the medical necessity process for accurate and timely payment for services, which may require negotiation with a payer on a case-by-case basis.

LOCAL CONTRACT NURSE RN - UTILIZATION REVIEW - $84 PER HOUR

Utilization Review Nurse

The Registered Nurse - Utilization Review at Ascension St. Vincent's Birmingham is responsible for providing health care services regarding admissions, case management, discharge planning, and utilization review. This role involves reviewing admissions and service requests for medical necessity, providing case management for complex cases, assisting staff with coding, documentation, and reimbursement issues, and overseeing compliance with utilization management rules. The position requires at least 3 years of acute care experience and utilization management experience.

Registered Nurse RN - Utilization Review  PRN

Registered Nurse - Utilization Review

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