Clinical Review Rn Jobs

RN Case Manager Location : Onsite in Dubuque, IA. We are seeking a compassionate and detail-oriented RN Case Manager to join our team. This role is responsible for delivering comprehensive case management services across the continuum of care. The RN Case Manager will assess, plan, implement, coordinate, monitor, and evaluate care for assigned consumers, ensuring quality outcomes and cost-effective treatment. Key Responsibilities: Provide telephonic case management and utilization review for assigned consumers. Develop, implement, and monitor individualized care plans to ensure quality and cost-effective outcomes. Collaborate with healthcare providers, payors, and internal teams to coordinate care. Serve as a liaison between consumers and benefit administrators, ensuring clear communication and support. Track and report case outcomes, including cost savings and quality improvements. Qualifications: Education: RN licensure in the State of Iowa required. BSN or higher preferred. Experience: Minimum 2 years of clinical practice. Case management or utilization review experience strongly preferred. Skills: Strong communication, problem-solving, and computer skills. Ability to work independently. Full-Time Benefits - Most benefits start day 1 Medical, Dental, Vision Insurance Flex Spending or HSA 401(k) with company match Profit-Sharing/Defined Contribution (1-year waiting period) PTO/Paid Holidays Company-paid ST and LT Disability Maternity Leave/Parental Leave Subsidized Parking Company-paid Term Life/Accidental Death Insurance About HealthCheck360 HealthCheck 360 was created with the employer's needs and the participant's experience in mind. We focus on reducing medical costs, while increasing employee engagement and productivity. This is accomplished by providing onsite biometric screenings, engaging participants through technology and programming, educating the participant with risk-specific targeted communications, and suppo

Bilingual RN Case Manager Location : Remote. We are seeking a compassionate and detail-oriented Bilingual RN Case Manager to join our team. This role is responsible for delivering comprehensive case management services across the continuum of care. The RN Case Manager will assess, plan, implement, coordinate, monitor, and evaluate care for assigned consumers, ensuring quality outcomes and cost-effective treatment. Key Responsibilities: Provide telephonic case management and utilization review for assigned consumers. Develop, implement, and monitor individualized care plans to ensure quality and cost-effective outcomes. Collaborate with healthcare providers, payors, and internal teams to coordinate care. Serve as a liaison between consumers and benefit administrators, ensuring clear communication and support. Track and report case outcomes, including cost savings and quality improvements. Qualifications: Bilingual: the ability to speak Spanish Education: RN licensure in the State of Iowa required. BSN or higher preferred. Experience: Minimum 2 years of clinical practice. Case management or utilization review experience strongly preferred. Skills: Strong communication, problem-solving, and computer skills. Ability to work independently. Full-Time Benefits - Most benefits start day 1 Medical, Dental, Vision Insurance Flex Spending or HSA 401(k) with company match Profit-Sharing/Defined Contribution (1-year waiting period) PTO/Paid Holidays Company-paid ST and LT Disability Maternity Leave/Parental Leave Subsidized Parking Company-paid Term Life/Accidental Death Insurance About HealthCheck360 HealthCheck 360 was created with the employer's needs and the participant's experience in mind. We focus on reducing medical costs, while increasing employee engagement and productivity. This is accomplished by providing onsite biometric screenings, engaging participants through technology and programming, educating the participant with risk-spec

Bilingual RN Case Manager Location : Onsite in Dubuque, IA. Also accepting remote applicants. We are seeking a compassionate and detail-oriented Bilingual RN Case Manager to join our team. This role is responsible for delivering comprehensive case management services across the continuum of care. The RN Case Manager will assess, plan, implement, coordinate, monitor, and evaluate care for assigned consumers, ensuring quality outcomes and cost-effective treatment. This role is based in our Dubuque office and is also available remotely. Key Responsibilities: Provide telephonic case management and utilization review for assigned consumers. Develop, implement, and monitor individualized care plans to ensure quality and cost-effective outcomes. Collaborate with healthcare providers, payors, and internal teams to coordinate care. Serve as a liaison between consumers and benefit administrators, ensuring clear communication and support. Track and report case outcomes, including cost savings and quality improvements. Qualifications: Bilingual: the ability to speak Spanish Education: RN licensure in the State of Iowa required. BSN or higher preferred. Experience: Minimum 2 years of clinical practice. Case management or utilization review experience strongly preferred. Skills: Strong communication, problem-solving, and computer skills. Ability to work independently. Full-Time Benefits - Most benefits start day 1 Medical, Dental, Vision Insurance Flex Spending or HSA 401(k) with company match Profit-Sharing/Defined Contribution (1-year waiting period) PTO/Paid Holidays Company-paid ST and LT Disability Maternity Leave/Parental Leave Subsidized Parking Company-paid Term Life/Accidental Death Insurance About HealthCheck360 HealthCheck 360 was created with the employer's needs and the participant's experience in mind. We focus on reducing medical costs, while increasing employee engagement and productivity. This is accomplished by providing onsite biom

Job Title: Registered Nurse – Care Management (Day Schedule) Location: 100% Remote - United States Employment Type: Full-Time W2 Hourly Compensation: $40 per hour We've increased our pay rate for this role - now $40/hour, up from $35/hour! Compact Multi-State Licensure Required CareTalk Health is a virtual medical practice that specializes in Clinical Process Outsourcing (CPO). We partner with healthcare organizations to build and manage patient and member populations. About the Role CareTalk Health is seeking experienced and highly organized Registered Nurses to join our virtual care team. This fully remote role blends care management, care navigation, and Annual Wellness Visit (AWV) chart preparation, supporting providers in delivering comprehensive, compliant, and patient-centered care. The RN Care Manager will manage medically complex patients, develop and monitor care plans across multiple programs (CCM, RPM, RTM, APCM), complete AWV chart preparation, and actively work to close care gaps, coordinate orders, and support preventive and chronic care initiatives. This role requires strong clinical judgment, excellent documentation skills, comfort with telehealth workflows, and the ability to work independently across multiple platforms. Schedule & Compensation 40 hours per week Day Shift : Start time between 7:30 AM–9:00 AM EST - End time between 4:00 PM–5:30 PM EST Weekend Requirement: All shift options include every other Saturday and Sunday Rotating holidays What You’ll Do Annual Wellness Visit (AWV) Chart Preparation · Prepare comprehensive AWV charts to support provider efficiency and CMS compliance. · Review and summarize with patients in face-to-face virtual visits via Zoom: · Medical, surgical, and family histories · Medication lists and adherence · Preventive screenings and immunizations · Cognitive, functional, and depression assessments · Identify overdue screenings, risk factors, and care gaps pri

Job Title: Registered Nurse – Care Management (Evening & Overnig Location: 100% Remote - United States Employment Type: Full-Time W2 Hourly Compensation: $40 per hour We've increased our pay rate for this role - now $40/hour, up from $35/hour! Compact Multi-State Licensure Required CareTalk Health is a virtual medical practice that specializes in Clinical Process Outsourcing (CPO). We partner with healthcare organizations to build and manage patient and member populations. About the Role CareTalk Health is seeking experienced and highly organized Registered Nurses to join our virtual care team. This fully remote role blends care management, care navigation, and Annual Wellness Visit (AWV) chart preparation, supporting providers in delivering comprehensive, compliant, and patient-centered care. The RN Care Manager will manage medically complex patients, develop and monitor care plans across multiple programs (CCM, RPM, RTM, APCM), complete AWV chart preparation, and actively work to close care gaps, coordinate orders, and support preventive and chronic care initiatives. This role requires strong clinical judgment, excellent documentation skills, comfort with telehealth workflows, and the ability to work independently across multiple platforms. Schedule & Compensation 40 hours per week Evening Shift : 2:30 PM - 11:00 PM EST Night Shift: 11:00 PM - 7:30 AM EST Weekend Requirement: All shift options include every other Saturday and Sunday Rotating holidays What You’ll Do Annual Wellness Visit (AWV) Chart Preparation · Prepare comprehensive AWV charts to support provider efficiency and CMS compliance. · Review and summarize with patients in face-to-face virtual visits via Zoom: · Medical, surgical, and family histories · Medication lists and adherence · Preventive screenings and immunizations · Cognitive, functional, and depression assessments · Identify overdue screenings, risk factors, and care gaps prior to visits. · Commun

Job Title: Registered Nurse – Virtual Care & Care Management (Remote) Location: 100% Remote - United States Employment Type: Full-Time W2 Hourly Compensation: $40 per hour We've increased our pay rate for this role - now $40/hour, up from $35/hour! Compact Multi-State Licensure Required CareTalk Health is a virtual medical practice that specializes in Clinical Process Outsourcing (CPO). We partner with healthcare organizations to build and manage patient and member populations. About the Role CareTalk Health is seeking experienced and highly organized Registered Nurses to join our virtual care team. This fully remote role blends care management, care navigation, and Annual Wellness Visit (AWV) chart preparation, supporting providers in delivering comprehensive, compliant, and patient-centered care. The RN Care Manager will manage medically complex patients, develop and monitor care plans across multiple programs (CCM, RPM, RTM, APCM), complete AWV chart preparation, and actively work to close care gaps, coordinate orders, and support preventive and chronic care initiatives. This role requires strong clinical judgment, excellent documentation skills, comfort with telehealth workflows, and the ability to work independently across multiple platforms. Schedule & Compensation · 40 hours per week · Core coverage Monday–Friday 9:00am–6:00pm EST · 1 Saturday per month (10:00am-4:00pm EST) · Rotating holidays What You’ll Do Annual Wellness Visit (AWV) Chart Preparation · Prepare comprehensive AWV charts to support provider efficiency and CMS compliance. · Review and summarize with patients in face-to-face virtual visits via Zoom: · Medical, surgical, and family histories · Medication lists and adherence · Preventive screenings and immunizations · Cognitive, functional, and depression assessments · Identify overdue screenings, risk factors, and care gaps prior to visits. · Communicate concise patient summaries and key findings to providers before eac

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary Normal Working Hours: Monday-Friday 8:00am - 4:30 pm in your local time zone There are no weekend hours. There are no holiday coverage hours. There is no travel. This is a 100% remote work from home position and candidates from any state with a compact RN license can apply. This position is for a NICU/ High-Risk Maternity case management team and experience with this is required. The Case Manager RN is responsible for telephonically and/or face to face assessing, planning, implementing, and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member’s overall wellness within a NICU/ high-risk maternity case management program. The Case Manager RN is empowered to take care of all aspects of a member's NICU and/ or maternity journey. The Case Manager RN develops a proactive course of action to address issues presented to enhance the short and long-term outcomes as well as opportunities to enhance a member’s overall wellness through integration. The Case Manager RN includes some of the following roles (not all inclusive): -Through the use of clinical tools and information/data review, conducts an evaluation of member's needs and benefit plan eligibility and facilitates integrative functions

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary: The Case Manager RN role is 100% remote work from home and candidates must have an active RN licensure (any state). Normal Working Hours: Monday through Friday 9:00am – 5:30pm in time zone of residence. Occasional evening, weekend, and holiday shifts per the needs of the team. No travel is expected with this position. The RN Case Manager is responsible for telephonically and/or face to face assessing, planning, implementing, and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member’s overall wellness. RN Case Manager: – Develops a proactive course of action to address issues presented to enhance the short and long-term outcomes as well as opportunities to enhance a member’s overall wellness through integration. – Through the use of clinical tools and information/data review, conducts an evaluation of member’s needs and benefit plan eligibility and facilitates integrative functions as well as smooth transition to Aetna programs and plans. – Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning and resolution of member issues. – Assessments take into account information from various sources to address all conditions incl

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Registered Nurse must hold a CDCES- Certified Diabetes Care and Education Specialist This is a full-time telework role for a RN who resides in a compact state and holds a compact license. Working schedule: Monday-Friday, standard business hours, including 1 evening shift per week from 12:30- pm EST -The Health Coach Consultant utilizes a collaborative process of assessment, planning, implementation and evaluation, to engage, educate, and promote and influence member's decisions related to achieving and maintaining optimal health status for chronic conditions. - Assessment of members through the use of clinical tools and information/data review, conducts comprehensive evaluation of member's needs and benefit plan eligibility for available integrated internal and external programs/services. -Utilizes assessment techniques to determine member's level of health literacy, technology capabilities, and/or readiness to change. -Enhancement of Medical Appropriateness & Quality of Care: -Application and/or interpretation of applicable criteria and guidelines, health/wellness management plans, policies, procedures, regulatory standards while assessing benefits and/or member's needs to enable appropriate utilization of services and/or administration and integration with available internal/external programs. -Usi

Become a part of our caring community The Pre-Authorization Nurse reviews prior authorization requests for appropriate care and setting, following guidelines and policies, and approves services or forward requests to the appropriate stakeholder. The Pre-Authorization Nurse 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The Pre-Authorization Nurse completes medical necessity and level of care reviews for requested services using clinical judgment, and refers to team members for review depending on case findings. Educate providers on utilization and medical management processes. Enter and maintain relevant clinical information in various medical management systems. Understand department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures. Use your skills to make an impact Required Qualifications 2+ years of RN experience Active RN license in the state of Indiana Ability to be licensed in multiple states without restrictions Previous experience in utilization management, case management, discharge planning and/or home health or rehab Proficient with MS Office products including Word, Excel and Outlook Ability to work independently under general instructions and with a team Preferred Qualifications Bachelor's degree MCO experience Health Plan experience working with large carriers Previous Medicare/Medicaid experience Outpatient or home health experience in Utilization Manageme

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary This is a full-time, remote, telehealth role. Must live in a compact state and hold a compact license in MT or PST zones. Working schedule is Monday-Friday, standard business hours in time zone of residence with one to two days per week until 7 PM MT or PST. This is an exciting team to join because we specialize in engaging and advocating for disengaged, vulnerable members who often have multiple medical, behavioral, and social challenges. We’re uniquely positioned to meaningfully improve health outcomes and costs. As Case Manager RN, you will be responsible for assessing, planning, implementing, and coordinating all case management activities with members to evaluate the medical needs of the member and facilitate the member’s overall wellness. You will develop a proactive course of action to address the issues presented to enhance their short and long-term outcomes as well as opportunities to enhance a member’s overall wellness through integration. You will also: Use clinical tools and information/data review to conduct an evaluation of members’ needs and benefits. Apply clinical judgment to incorporate strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning. Conduct assessmen

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary This critically important role is responsible for providing consultative support to contracted Skilled Nursing (SNF) and Assisted Living (ALF) facilities. The Clinical Nurse for LTC (Long Term Care) will work collaboratively with other Omnicare disciplines to develop client relationships, aid in the retention and expansion of existing business, and help to ensure execution of contracted nursing reviews. This field position will cover the state of Washington, Oregon, Idaho, and Northern California. Travel will mostly be in the state of Washington with occasional travel to the others states listed. Expect to be traveling up to 4 nights a week, away from home. The Clinical Nurse Specialist/Infusion Educator LTC is responsible for the below, most of which must be completed on-site within LTC facilities: • Build strong client relationships by consistently delivering client interactions that develop trust and show value • Evaluate regulatory compliance and determine clinical education needs for our clients as it relates to pharmacy services • Conduct Quality Assurance audits to assist client facilities in preparation for regulatory surveys including: Auditing medication carts, medication rooms, observing medication pass, and sample resident chart reviews • Identify and provide recommendations regarding deficiencies and opportunities around drug inven

Become a part of our caring community The Utilization Management Registered Nurse uses clinical nursing skills to interpret and support the coordination, documentation and communication of medical services and benefit administration determinations. You will report to the Manager of Utilization Management and serve as a member of the One Home/Home Solutions Utilization Management team. This team manages post-acute care services. These services include Skilled Nursing Facility (SNF), Home Health, and Durable Medical Equipment (DME). The team's goal is to ensure members receive the appropriate level of care in the most appropriate setting. As a Utilization Management Registered Nurse: You will use clinical nursing skills to interpret and support the coordination, documentation and communication of medical services and benefit administration determinations. Using established medical criteria, you will make determinations based on information provided by the attending physician and other care providers You will complete request determinations within established processing time frames. (i.e. 10 reviews per day?) You will communicate with providers, members, or other parties to facilitate care and treatment. You will help deliver coordinated care for our members You will understand department, segment, and organizational strategy and operating goals, including their linkages to related areas. Use your skills to make an impact Required Qualifications: Must hold Compact Registered Nurse (RN) license in your state of residence Greater than one year of clinical experience as a RN in a hospital, SNF, Home Health, or acute care setting. Must be passionate about contributing to an organization focused on improving consumer experiences Preferr

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary This position is responsible for performing utilization management (UM) reviews and authorization activities for post-acute services, including Skilled Nursing Facilities (SNF), Inpatient Rehabilitation Facilities (IRF), Long-Term Acute Care Hospitals (LTACH), Home Health, and other post-acute levels of care. The UM Nurse Consultant evaluates medical necessity and appropriateness of services utilizing clinical criteria, applicable policies, and regulatory requirements to support quality, cost-effective care. The UM Nurse Consultant collaborates with providers, care managers, medical directors, and interdisciplinary teams to facilitate timely care transitions, ensure member needs are met, and support organizational goals. This role requires independent clinical judgment, strong critical thinking skills, and the ability to manage multiple priorities in a fast-paced environment. Required Qualifications Active, unrestricted Registered Nurse (RN) license in the state of residence. Ability to obtain and maintain additional state licensure as required by business needs. 3+ years of clinical nursing experience. 1+ years of utilization management, case management, discharge planning, managed care, or post-acute care experience. Experience reviewing medical records and applying evidence-based

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Case Manager (RN) – Field Location: Mesquite, Balch Springs, Forney, Talty, Seagoville, Hutchins, Lancaster, Ferris, Red Oak, Cockrell Hill, Cedar Hill, Wilmer, West Dallas, Highland Park and South Dallas (Remote with local travel) Travel: Up to, 75% within territory Position Summary Nurse Case Manager (RN) for a work-from-home role that requires frequent local travel for in-home member visits and occasional visits to nursing facilities within the Dallas & Surrounding Areas in Texas In this role, you will deliver high-quality case management services through a combination of telephonic and face-to-face engagement, helping members navigate their healthcare needs and achieve improved health outcomes. Key Responsibilities Conduct comprehensive telephonic and in-person assessments to evaluate members' medical and behavioral health needs Develop and implement individualized care plans, ensuring alignment with clinical and program guidelines Coordinate and monitor ongoing care plan activities, adjusting as needed to improve outcomes Collaborate in multidisciplinary care reviews to optimize member health results Identify and escalate quality of care concerns through appropriate channels Engage members using motivational interviewing and coaching techniques to encourage healthy lifes