Medical Review Manager Jobs

Peraton's SafeGuard Services seeks a seasoned Medical Review Manager (RN) to lead and develop a nursing medical-review team focused on detecting and referring Medicare and Medicaid fraud, waste, and abuse.

Lead and coordinate the promotional review committee process at Ascendis Pharma—managing Veeva-driven reviews, cross-functional stakeholders, training, and process improvements to ensure compliant and efficient approvals.

Highmark is hiring a Remote Medical Case Manager (PA-licensed) to coordinate care, develop individualized plans, and manage complex medical and psychosocial cases for Pennsylvania members.

Experienced quality leader needed to design and operationalize contract-level quality solutions that improve performance across Stars, HEDIS, and MIPS for a national physician enablement platform.

Provide inpatient rehabilitation case management (RN or LMSW) on a per-diem basis, coordinating care, discharge planning, and utilization management for complex rehab patients at Ochsner Rehabilitation Hospital.

Centinela Hospital Medical Center is hiring an RN Case Manager to coordinate inpatient care, perform concurrent review for medical necessity, and support cost-effective, high-quality patient outcomes.

Select Medical in Mount Clemens is seeking an experienced RN/RT/SW Case Manager to manage utilization review, discharge planning and multidisciplinary coordination for complex, post-ICU patients.