- Emory Healthcare/Emory University (Atlanta, GA)
- …mentorship, _development,_ and leadership programs + And more **Description** We're seeking an ** Inpatient Registry Utilization Review Nurse (PRN)** who is ... physician and/or physician advisor. This individual will: + Perform utilization review by completing a timely and... review by completing a timely and comprehensive review of all new observation and inpatient … more
- Cognizant (Atlanta, GA)
- …Monday to Friday - Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced level work related to ... as well as timely filing deadlines and processes. . Review clinical denials including but not limited to referral,...to have to be considered** . Educational background - Registered Nurse (RN) . 2-3 years combined clinical and/or… more
- Centene Corporation (Atlanta, GA)
- …and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and ... appropriateness in accordance with regulatory guidelines and criteria + Performs concurrent review of behavioral health (BH) inpatient to determine overall… more
- Molina Healthcare (Atlanta, GA)
- …* At least 2 years experience, including experience in hospital acute care, inpatient review , prior authorization, managed care, or equivalent combination of ... JOB DESCRIPTION Job SummaryProvides support for clinical member services review assessment processes. Responsible for verifying that services are...relevant education and experience. * Registered Nurse (RN). License must be active and unrestricted… more
- Molina Healthcare (Atlanta, GA)
- …experience, preferably in a hospital setting, including at least 1 year of utilization review , medical claims review , claims auditing, medical necessity ... claim review including diagnosis-related group (DRG) validation, itemized bill review , appropriate level of care, inpatient readmission, and any opportunity… more
- Molina Healthcare (Atlanta, GA)
- …* At least 2 years experience, including experience in hospital acute care, inpatient review , prior authorization, managed care, or equivalent combination of ... relevant education and experience. * Registered Nurse (RN). License must be active and unrestricted...in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management… more
- Molina Healthcare (Atlanta, GA)
- …SKILLS & ABILITIES:** + Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years ... Assists with Complex Claim review including DRG Validation, Itemized Bill Review , Appropriate Level of Care, Inpatient Readmission, and any opportunity… more
- Elevance Health (Atlanta, GA)
- …medication use. This role supports key clinical pharmacy programs, including Drug Utilization Review (DUR), Drug Information Services (DIS), and formulary ... resource to other pharmacists on areas such as prospective, inpatient and retrospective DURs and provides dosage conversion and...state or territory of the United States when conducting utilization review or an appeals consideration and… more