Utilization Management, Registered Nurse RN Clover Health Investments CorpUtilization Management, Registered Nurse RNNYRemote$90,000–$106,000 / yearAs a Utilization Management, Registered Nurse (RN), you will: Perform medical necessity reviews for prior authorization and concurrent review across acute inpatient, post-acute (SNF, IRF, LTACH) and outpatient services Apply CMS Medicare guidelines, NCD/LCD policies, and MCG criteria to support determinations Manage cases end-to-end from prior authorization through concurrent review and discharge Collaborate with providers and facilities to obtain clinical information and support care coordination Ensure compliance with CMS turnaround times and regulatory requirements Participate in Quality Assurance (QA) activities, including case audits and peer reviews to ensure accuracy and consistency in decision-making Have strong personal accountability, responsibility and independent decision-making abilities. Additional Perks: Employee Stock Purchase Plan (ESPP) offering discounted equity opportunities Reimbursement for office setup expenses Monthly cell phone & internet stipend Remote-first culture, enabling collaboration with global teams Paid parental leave for all new parents * And much more!
Bilingual Pediatric Registered Nurse Imagine Pediatrics LLCBilingual Pediatric Registered NurseNYRemote$40–$47 / hourAs a Pediatric Registered Nurse at Imagine Pediatrics, you are the primary point of contact for our families as you work to deeply know our patients through frequent virtual touchpoints and are the first line of defense when our patients are having a clinical problem. You leverage an integrated technology platform and are complimented by an entire interdisciplinary team including MDs, APPs, social workers, navigators, pharmacists, and dietitians.
Telehealth Triage Registered Nurse New York + Compact State RN License Required Ophelia Health IncTelehealth Triage Registered Nurse New York + Compact State RN License RequiredNew York, NYRemoteTriage RNs have experience working with patients with substance use and are comfortable conducting ongoing medication management, performing check-in calls and urine drug screens, assessing bridge prescription requests, and identifying escalation events requiring clinical oversight. Support medication management by communicating with patients regarding medication dosing, interactions, and taking meds as prescribed; discussing comfort medications during the induction phase, and educating patients on proper dosing method of buprenorphine.
Registered Nurse Case Manager - Field in Essex and surrounding counties New Jersey CVS HealthRegistered Nurse Case Manager - Field in Essex and surrounding counties New JerseyEast Orange, New JerseyRemoteComfort conducting field‑based home visits across all socioeconomic levels and community settings, including any neighborhood or environment, and with members in a wide range of living conditions or circumstances. You’ll leverage your clinical expertise to develop individualized care plans, coordinate physical, behavioral, and psychosocial services, and ensure members receive the support they need to thrive.
Case Manager Registered Nurse - Field in Essex County, NJ CVS Health CorpCase Manager Registered Nurse - Field in Essex County, NJEast Orange, NJRemote$66,575–$142,576 / yearBenefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. Comfort conducting field-based home visits across all socioeconomic levels and community settings, including any neighborhood or environment, and with members in a wide range of living conditions or circumstances.
Registered Nurse #26-15220 US Tech Solutions, Inc.Registered Nurse #26-1522037 BROADWAY, NYRemote$38–$50 / hourThe RN will administer state-approved immunizations, including pediatric vaccinations, while ensuring safe patient care and accurate documentation. US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions.
Registered Nurse (RN) – Principal Care Management (PCM) Elaya HealthRegistered Nurse (RN) – Principal Care Management (PCM)passaic, NJRemoteReview patient charts, medications, labs, and care plans• Coordinate care with providers, nursing staff, pharmacies, and families when needed• Document patient interactions accurately and thoroughly• Identify changes in condition and escalate concerns appropriately• Assist with chronic disease management and patient education• Ensure PCM services are completed in compliance with CMS guidelines. • Active RN license required• Nursing home or long term care experience preferred• Experience with chronic care management or PCM is a plus• Strong communication and organizational skills• Comfortable working independently in a remote environment• EMR experience preferred.
NewClinical Information Specialist - IV (EX) Integrated Resources, IncClinical Information Specialist - IV (EX)Florham Park, NJRemoteDay-to-day responsibilities include hosting Faculty Advancement Program trainings for healthcare providers, demonstrating Nexplanon insertion using models, ensuring compliance and FDA-required documentation, scheduling, paperwork, signatures, and filing in Veeva. Serve as a liaison between healthcare providers and internal stakeholders, ensuring effective communication while adhering to company policies and applicable FDA and local health authority requirements.
Registered Nurse, Clinical Delivery Care Access Research LLCRegistered Nurse, Clinical DeliveryNYRemote$34–$48 / hourWith programs like Future of Medicine, which makes advanced health screenings and research opportunities accessible to communities worldwide, and Difference Makers, which supports local leaders to expand their community health and wellbeing efforts, we put people at the heart of medical progress. Furthermore, they serve as a point of escalation for the Member Services team, addressing complex inquiries related to lab results and assisting in the resolution of patient concerns by providing clinical insights and ensuring patients receive accurate information and appropriate follow-up.
Case Manager Registered Nurse - Field (Monmouth/Ocean) County, NJ CVS HealthCase Manager Registered Nurse - Field (Monmouth/Ocean) County, NJMontclair, New JerseyRemoteWith compassionate attention and excellent communication, we collaborate with members, providers, and community organizations to address the full continuum of our members’ health care and social determinant needs. Collaborates with supervisor and other key stakeholders in the member’s healthcare in overcoming barriers in meeting goals and objectives, presents cases at interdisciplinary case conferences.
Case Manager Registered Nurse - Field (Somerset County, New Jersey) CVS Health CorpCase Manager Registered Nurse - Field (Somerset County, New Jersey)Somerset County, NJRemote$66,575–$142,576 / yearWith compassionate attention and excellent communication, we collaborate with members, providers, and community organizations to address the full continuum of our members' health care and social determinant needs. Collaborates with supervisor and other key stakeholders in the member's healthcare in overcoming barriers in meeting goals and objectives, presents cases at interdisciplinary case conferences.
Case Manager Registered Nurse - Field (Cumberland/Atlantic ) County, NJ CVS Health CorpCase Manager Registered Nurse - Field (Cumberland/Atlantic ) County, NJMontclair, NJRemote$66,575–$142,576 / yearWith compassionate attention and excellent communication, we collaborate with members, providers, and community organizations to address the full continuum of our members' health care and social determinant needs. Collaborates with supervisor and other key stakeholders in the member's healthcare in overcoming barriers in meeting goals and objectives, presents cases at interdisciplinary case conferences.
Clinical Review & Correspondence RN Cohere Health Technologies LLCClinical Review & Correspondence RNNYRemote$31–$35 / hourBy unifying pre-service authorization data with post-service claims validation, we're creating a transparent healthcare ecosystem that reduces waste, improves payer-provider collaboration and patient outcomes, and ensures providers are paid promptly and accurately. Opportunity Overview: The Clinical Review & Correspondence RN plays a critical role in supporting utilization management operations by conducting medical necessity reviews, preparing clear and compliant clinical determinations, and ensuring accurate member and provider communications.
NewContractor, Clinical Liaison Net2SourceContractor, Clinical LiaisonFlorham Park, NJRemote$97–$97.82 / hourDay-to-day responsibilities include hosting Faculty Advancement Program trainings for healthcare providers, demonstrating Nexplanon insertion using models, ensuring compliance and FDA-required documentation, scheduling, paperwork, signatures, and filing in Veeva. Position Overview The Clinical Liaison acts as a liaison for healthcare providers, supporting the clinical use of implantable contraception for trained clinicians with Nexplanon.
NewRN Health Care Facility Surveyor Impact Recruiting SolutionsRN Health Care Facility SurveyorBronx, New YorkRemote$75,000–$90,000The Surveyor will serve as a team member or team leader on various types of surveys (i.e. re-certification, comparative, complaint investigation, and revisits) for long-term care and non-long-term care surveys, which can include; ambulatory surgical centers (ASC), Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICFs/IID), end-stage renal disease (ESRD), Psychiatric Residential Treatment Facility (PRTF), hospital, critical access hospital, and hospice facilities. Impact Recruiting Solutions is currently seeking a RN Health Care Facility Surveyor to fill an opening with a Quality Improvement Consulting Company and will work in a technically exciting environment supporting internal and external customers nationwide.
NewCare Manager (RN) Centene Corporation GroupCare Manager (RN)NJRemote$56,200–$101,000 / yearPosition Purpose: Develops, assesses, and facilitates complex care management activities for primarily physical needs members to provide high quality, cost-effective healthcare outcomes including personalized care plans and education for members and their families. Provides ongoing follow up and monitoring of member status, change in condition, and progress towards care plan / service plan goals; collaborate with member, caregivers, and appropriate providers to revise or update care plan / service plan as necessary to meet the member's goals / unmet needs.
Behavioral Health RN Greenlife Healthcare StaffingBehavioral Health RNNew York, NYRemote$60,000–$68,000Reports to the Program Lead/Health Information Technology Subject Matter Expert; Provides subject matter expertise in the development of resources and identification of best practices around the use of evidence-based guidelines to identify and treat tobacco use disorder; and. This 1099 contract role serves as a Behavioral Health Subject Matter Expert, providing clinical expertise in the development of resources and identification of best practices around evidence-based guidelines to identify and treat tobacco use disorder (TUD).
Complex Oncology Nurse Navigator (11:30AM - 8:00PM EST) Thyme Care IncComplex Oncology Nurse Navigator (11:30AM - 8:00PM EST)NYRemoteToday, Thyme Care is a market-leading value-based oncology care enabler, partnering with national and regional health plans, providers, and employers to deliver better outcomes and lower costs for thousands of people across the country. In it, you will conduct clinical assessments, monitor for changes in health, coordinate care, including transitions, and educate members and caregivers about their diagnosis and treatment over the phone to support our higher-acuity members as they move through the oncology care continuum.
Oncology Transitions of Care Nurse (11:30AM - 8:00PM EST) Thyme Care IncOncology Transitions of Care Nurse (11:30AM - 8:00PM EST)NYRemoteToday, Thyme Care is a market-leading value-based oncology care enabler, partnering with national and regional health plans, providers, and employers to deliver better outcomes and lower costs for thousands of people across the country. In it, you will conduct clinical assessments, monitor for changes in health, coordinate care, including transitions, and educate members and caregivers about their diagnosis and treatment over the phone to support our members as they move through the oncology care continuum.
Psychiatric Nurse Practitioner (Full-Time W2) Reklame HealthPsychiatric Nurse Practitioner (Full-Time W2)New York, New YorkRemote$110,000–$140,000 / yearWe are a clinician-led, tech-enabled provider group that exists to provide culturally competent behavioral health care addiction care, medication management, crisis intervention, and care coordination for people working towards taking back control of their lives, while expanding access to care. Psychiatric Evaluations and Medication Management : Deliver compassionate and high-quality psychiatric care, addiction care, and medication management through a convenient telehealth platform, ensuring members receive accessible and effective care.