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Clinical Review Nurse
HealthHelp
About the role Join WNS as a Clinical Review Nurse and perform utilization reviews to ensure medical necessity compliance with client policies and regulatory standards. You will work closely with prov...
Appeals Registered Nurse
WPS—A health solutions company
About the role The Appeals Registered Nurse reviews medical records and claim information for first‑level appeal cases to determine medical necessity and Medicare coverage compliance. This role works...
Outpatient Prior Authorization Nurse
Imperial Health Plan of California, Inc.
About the role We are seeking an Outpatient Prior Authorization Nurse to review authorization requests, ensure medical necessity, and support cost-effective patient care. The role involves applying cl...
About the role The Utilization Case Manager RN at the University of Miami reviews patient charts to determine medical necessity and coordinate prior authorizations. The role ensures timely communicati...
CNC Operator Level 3 – 2nd Shift
reliablesfc
About the role CNC Operator Level 3 – 2nd Shift. The following is a list of general responsibilities and skills necessary to perform the duties of the CNC Level 3 classification (labor grade 9). Key r...
Full-Time Outpatient Scheduler – Centralized Scheduling
Kingman Healthcare Inc.
About the role The Outpatient Scheduling Representative is responsible for financially clearing outpatient referrals. This includes validating orders, checking medical necessity, verifying insurance e...
Comprador – Gestión completa del ciclo de compras
Grupo Roca C.A.
Acerca del puesto Como Comprador en Grupo Roca C.A., serás responsable de gestionar todo el ciclo de compras, desde la identificación de necesidades internas hasta la negociación y cierre de órdenes c...
Practicante de mercadeo o marketing para investigación de mercados
EcoPower - Eficiência Energética
Acerca del puesto Buscamos estudiante activo de Mercadeo, Administración de Empresas, Comunicación o carreras afines que necesite realizar la práctica como requisito universitario. Interés en investig...
Clinical Review Nurse – Utilization Review
HealthHelp
About the role We are seeking a qualified Nurse to perform utilization reviews of medical cases, ensuring each request meets established medical necessity criteria. The role involves close collaborati...
Utilization Management RN (Compact Licensed)
Clearlink Partners
About the role Clearlink Partners is seeking a Registered Nurse with a compact license to join its managed‑care consultancy team. The Utilization Management RN will evaluate the medical necessity and...
Clinical Review Nurse – Concurrent Review (Remote)
Centene Corporation
About the role Centene is seeking a Clinical Review Nurse to perform concurrent reviews for members across its health plan in Oregon. This fully remote position evaluates medical necessity, quality of...
Remote Pharmacist – Prior Authorization & Utilization Management
Molina Healthcare
About the role Molina Healthcare is seeking a remote Pharmacist to join its Utilization Management (UM) and Prior Authorization team. The pharmacist will ensure members receive medically necessary pre...
About the role We are seeking a Registered Nurse to join our remote Utilization Management team serving the PA, NJ, and DE tri‑state area. The RN will review inpatient admissions, ensure medical neces...
Clinical Appeal Revenue Integrity Nurse Auditor
CentraState Healthcare System
About the role CentraState Healthcare System seeks a Clinical Appeal Revenue Integrity Nurse Auditor to ensure clinical documentation meets medical necessity standards and to manage appeal processes f...
About the role We are seeking an experienced Registered Nurse to join our Utilization Management Appeals team as a Care Manager. This full‑time contract role focuses on reviewing medical necessity, ma...
About the role We are looking for an experienced MD or DO to join our Utilization Management team as a Physician Reviewer. This remote, full‑time position focuses on evaluating the medical necessity o...