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

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 - 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

Registered Nurse - Review Analyst

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 Payment Integrity RN at Cambia Health Solutions, Inc. is responsible for conducting post-service review of claims in prepayment, post-payment, or audit capacity to ensure appropriate clinical review, reimbursement of claims, and accuracy of coding. This role involves applying internal medical and reimbursement policies, as well as correct coding guidelines based on national standards, all in service of making members' health journeys easier. The position offers the opportunity to work from home within Oregon, Washington, Idaho, or Utah.

Payment Integrity RN

Payment Integrity Registered 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

The Correctional RN at Amergis works in collaboration with healthcare professionals, correctional officers, and administrators to ensure the well-being of the incarcerated population. This role involves providing routine and emergency healthcare in a correctional facility setting, utilizing the nursing process to assess, plan, implement, and evaluate patient care.

RN Corrections

Registered Nurse Corrections

Two immediate vacancies for dedicated registered nurses in Irving, Texas, working remotely. The role involves using Axxess software for home health care, including start of care, revisits, and discharges. The nurse will collaborate with other healthcare professionals to ensure comprehensive patient care.

Remote Home Health Nurse

Remote Licensed Registered Nurse for Home Care

The Registered Nurse for the Minimum Data Set at Ascension Living is responsible for collecting data for use in determining care plans, ensuring the accuracy of patient charts and medical data, and participating in the CMS survey process. This role is part of an interdisciplinary team and requires current knowledge of federal, state, and local standards and regulations for long-term care. The position is remote and offers a variety of benefits, including paid time off, health insurance options, retirement benefits, and more.

RN-Minimum Data Set

Registered Nurse - Minimum Data Set

Health Advocates Network is seeking a Registered Nurse for the ICU. The role involves providing exceptional customer service and healthcare staffing, with opportunities ranging from Per Diem to Travel Contracts. The company offers comprehensive benefits, competitive pay, and educational opportunities, aiming to improve healthcare staffing and support the career advancement of healthcare professionals.

RN - ICU

Registered Nurse - ICU

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

The Utilization Review Nurse is responsible for the review of precertification admission and concurrent reviews for the appropriateness of the inpatient setting utilizing InterQual criteria. This role involves entering or referencing data via PC, collaborating with facilities, providers, and Medical Directors, and requires excellent written and oral communication skills. The position is remote, with a work location in Detroit, MI, and is a 10-month contract job type.

The Triage Nurse (RN) at CenterWell is responsible for assessing patients' health problems and needs, developing and executing nursing care plans, and assisting in maintenance of patient medical records. This role involves varied work assignments that require interpretation and independent determination of appropriate courses of action. The position is remote and telephonic, focusing on evaluation of patients with ambulatory diagnoses as well as possible acute conditions and medication refills, in partnership with the center's mid-levels and PCPs.

Triage Nurse - CenterWell - Eastside

Triage Nurse

We are seeking a Registered Nurse Coder to join our team in the healthcare industry, working remotely with EST hours. This role involves working on a COC/SPD project to build out the coding for our benefit plans, utilizing clinical knowledge and coding skills to support project deliverables. The position offers an opportunity to work in a thriving sector and contribute to the team's objectives.

Registered Nurse Coder

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