- Harbor Health Services, Inc. (Mattapan, MA)
- … management including UM/CM, Grievance and Appeals, inpatient and outpatient services, medical policy, and clinical claims review In-depth experience ... function. Ensures timely responses to all requests related to medical review decisions and authorization issues from...or finance department. Works with UM RNs and Senior Medical Director to deny claims when appropriate.… more
- Aveanna Healthcare (Madison, WI)
- …patient admissions and continuity of care are held. Monitor and review client satisfaction survey results across branches, developing and implementing improvement ... in the day to day branch management including comprehensive review of financial statements, business planning, P&L responsibilities, productivity reports/staffing,… more
- Houston Methodist (Houston, TX)
- …the Utilization Review Specialist Nurse (URSN) position is a licensed registered nurse ( RN ) who comprehensively conducts point of entry and ... concurrent medical record review for medical ...and/or case management **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse -… more
- Ascension Health (Tulsa, OK)
- …processes and procedures. **Requirements** Licensure / Certification / Registration: + Registered Nurse credentialed from the Oklahoma Board of Nursing ... claims , qualityindicators and other risk-related data. + Coordinate the medical staff's professional performance evaluation and peer review programs in… more
- InGenesis (Columbia, SC)
- InGenesis is currently seeking a Registered Nurse / RN - Managed Care Coordinator to work for our client located in Columbia, SC. In this role you will ... any questions you may have. Job Duties * Perform medical review /authorization process. * Ensure coverage for...Perform other duties as assigned. Minimum Qualifications * Current Registered Nurse / RN license… more
- The County of Los Angeles (Los Angeles, CA)
- …be active and unrestricted. Successful candidates are required to provide proof of their Registered Nurse ( RN ) License and Basic Life Support (BLS) ... REGISTERED NURSE I/RELIEF NURSE ...vaccination against COVID-19 or request an exemption for qualifying medical or religious reasons during the onboarding process. Candidates… more
- US Tech Solutions (Columbia, SC)
- …Utilizes available resources to promote quality, cost effective outcomes. Performs medical or behavioral review /authorization process. Ensures coverage for ... then will go remote. **Responsibilities:** + Reviews and evaluates medical or behavioral eligibility regarding benefits and clinical criteria...the state of hire, OR active compact multistate unrestricted RN license as defined by the Nurse … more
- US Tech Solutions (Columbia, SC)
- …available resources to promote quality, cost effective outcomes. + Performs medical or behavioral review /authorization process. Ensures coverage for appropriate ... temp to hire)** **Job Description:** + Must be an RN in SC and have an active and unrestricted...weeks remote position after training. + Reviews and evaluates medical or behavioral eligibility regarding benefits and clinical criteria… more
- The County of Los Angeles (Los Angeles, CA)
- REGISTERED NURSE I, SHERIFF (CORRECTIONAL HEALTH) Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/2930992) Apply REGISTERED NURSE ... is currently offering up to 20% bonus for full-time Registered Nurse I, Sheriff positions hired by...vaccination against COVID-19 or request an exemption for qualifying medical or religious reasons during the onboarding process. Candidates… more
- Commonwealth of Pennsylvania (PA)
- …nursing practices. Work is reviewed and evaluated by a Registered Nurse Supervisor, physician or dentist through observation, review of reports and ... Registered Nurse - SCI Muncy (12 Hour Shifts)...in a patient or resident care area or in a medical clinic in the Youth Development Center (YDC) system, a… more
- MyFlorida (Orlando, FL)
- …that all verbal orders, including telephone orders from attending physicians, are reviewed by a registered nurse . + If no RN is available, receive all ... reflective of resident's status, and providing supervision and guidance to the Registered ( RN ), Licensed Practical Nurse (LPN), Certified Nursing… more
- Emanate Health (Covina, CA)
- …States, and the #19 ranked company in the country. **J** **ob Summary** The Utilization Review Nurse will evaluate medical records to determine medical ... protocol sets, or clinical guidelines and provide support and review of medical claims and...customer service skills required. **Minimum License Requirement :** California RN license. Delivering world-class health care one patient at… more
- MyFlorida (St. Augustine, FL)
- …all verbal orders, including telephone orders from attending physicians, are reviewed by a registered nurse . If no RN is available, receive all telephone ... SENIOR REGISTERED NURSE SUPV - 50950032 Date:...history must be verifiable. Please attach any credentials you claim (degrees, certifications, etc.) to your application. *Other vacant… more
- Cognizant (Salem, OR)
- …expectations. **What you need to have to be considered** + Educational background - Registered Nurse ( RN ) + 2-3 years combined clinical and/or utilization ... Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact...the medical necessity determinations to the Health Plan/ Medical Director based on the review of… more
- MyFlorida (Orlando, FL)
- REGISTERED NURSE Date: Dec 1, 2025 The State Personnel System is an E-Verify employer. For more information click on our E-Verify Website ... . Requisition No: 860343 Agency: Veterans Affairs Working Title: REGISTERED NURSE Pay Plan: Career Service Position Number:… more
- CVS Health (Richmond, VA)
- …including NCQA standards. **Required Qualifications** + Candidate must have an active and unrestricted Registered Nurse ( RN ) License in Virginia OR Compact ... who cannot advocate for themselves. The TOC team will review prior claims to address potential impact...Registered Nurse ( RN ) License in state of residence… more
- MyFlorida (Pembroke Pines, FL)
- OPS REGISTERED NURSE - 50509374 Date: Dec 10, 2025 The State Personnel System is an E-Verify employer. For more information click on our E-Verify Website ... . Requisition No: 866646 Agency: Veterans Affairs Working Title: OPS REGISTERED NURSE - 50509374 Pay Plan: Health Care Practice… more
- CP Unlimited (Carmel, NY)
- Registered Nurse Type of Position Full...semiannual basis or as indicated. + Coordinate with the Medical Case Manager Counselors (MCMC) to ensure medical ... NY, Yonkers, NY Apply Now (https://phe.tbe.taleo.net/phe03/ats/careers/v2/applyRequisition?org=CPOFNYS&cws=45&rid=6353) Job Brief The Registered Nurse shall provide health related services… more
- Beth Israel Lahey Health (Burlington, MA)
- …taking a job, you're making a difference in people's lives.** RN - Employee Health Nurse - Lahey Medical Center - Burlington, MA. 32 hrs. Days M-F. RN ... health care services to employees. **Job Description:** ** RN - Employee Health Nurse - Lahey Medical Center - Burlington, MA.** **Job Description:** 1.… more
- CVS Health (Springfield, VA)
- …current unrestricted Virginia state licensure required - 3+ years clinical experience as a Registered Nurse (ie med surg, behavioral health, acute care) - Must ... or Surrounding Areas. Monday-Friday Standard Business Hours. **Roles and Responsibilities** Nurse Case Manager is responsible for telephonically and/or face to face… more
