- Humana (Atlanta, GA)
- …community and help us put health first** Full-Time, Remote Telephonic opportunity The Utilization Management Nurse 2 utilizes clinical nursing skills to ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- CVS Health (Atlanta, GA)
- …all with heart, each and every day. **Position Summary** Medicare Predetermination Utilization Management Nurse Consultant position: _Utilization ... with occasional holiday rotation.** **Preferred Qualifications** + Prior Authorization or Utilization Management experience + Managed care experience +… more
- Humana (Atlanta, GA)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- Cognizant (Atlanta, GA)
- …background - Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management experience with managed health care plan . 3 years' experience ... Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced...care revenue cycle or clinic operations . Experience in utilization management to include Clinical Appeals and… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …leadership programs + And more **Description** We're seeking an **Inpatient Registry Utilization Review Nurse (PRN)** who is responsible for conducting medical ... with the attending physician and/or physician advisor. This individual will: + Perform utilization review by completing a timely and comprehensive review of all new… more
- CVS Health (Atlanta, GA)
- …clinical skills to coordinate, document and communicate all aspects of the utilization /benefit management program. Applies critical thinking and is knowledgeable ... and external constituents in the coordination and administration of the utilization /benefit management function. **Required Qualifications** + 3+ years post… more
- Elevance Health (Atlanta, GA)
- ** Utilization Management Representative I** **Virtual:** This role enables associates to work virtually full-time, with the exception of required in-person ... an accommodation is granted as required by law._ The ** Utilization Management Representative I** will be responsible...requests. + Refers cases requiring clinical review to a Nurse reviewer. + Responsible for the identification and data… more
- Centene Corporation (Atlanta, GA)
- …hours.** **The ideal candidate will have experience in behavioral health utilization management .** **Education/Experience:** Requires Graduate of an Accredited ... 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive… more
- Sharecare (Atlanta, GA)
- …appropriate resource utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during their interactions with participants ... for everyone. To learn more, visit www.sharecare.com . **Job Summary:** The Disease Management Nurse has the responsibility for supporting the goals and… more
- Veterans Affairs, Veterans Health Administration (Atlanta, GA)
- …expert leadership, experience, and creative approaches in providing complex patient management . Holds the responsibility of implementing an efficient approach to ... receiving home health care services. Adherence to VA-mandated processes and the utilization of health information solutions to assess, document, exchange, and track… more
- CVS Health (Atlanta, GA)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... Abuse or Maternity/ Obstetrics experience. **Preferred Qualifications** + 1+ years' Case Management experience or discharge planning, nurse navigator or nurse… more
- Elevance Health (Atlanta, GA)
- **Medical Management Nurse ** **Hours: Candidates will work 8a-5pm PST with 1 weekend per year-open for weekend work holidays voluntary** **Location** : This role ... accommodation is granted as required by law. The **Medical Management Nurse ** is responsible for review of...in multiple states. **Preferred Skills, Capabilities & Experiences:** + Utilization management experience. + Strong of computer… more
- ChenMed (Decatur, GA)
- … management programs, clinical meetings and other meetings. The Nurse Practitioner, Specialty incumbent adheres to strict departmental goals/objectives, standards ... we need great people to join our team. The Nurse Practitioner (NP), Specialty acts as part of the...nursing plan of care, health education, physician referrals, case management referrals, follow-up and clear documentation according to ChenMed… more
- Molina Healthcare (Atlanta, GA)
- …reports submitted to the Eastern US Quality Improvement Collaborative (EQIC) and/or utilization management committees. + Participates as needed in joint ... **JOB DESCRIPTION** **Job Summary** The Delegation Oversight Nurse provides support for delegation oversight quality improvement activities. Responsible for… more
- ChenMed (Morrow, GA)
- … management programs, clinical meetings and other meetings. The Nurse Practitioner will adhere to strict departmental goals/objectives, standards of performance, ... we need great people to join our team. The Nurse Practitioner (NP) acts as part of the clinical...nursing plan of care, health education, physician referrals, case management referrals, follow-up and clear documentation according to ChenMed… more
- Molina Healthcare (Atlanta, GA)
- …of payment decisions. * Serves as a clinical resource for utilization management , chief medical officers, physicians and member/provider inquiries/appeals. ... JOB DESCRIPTION **Job Summary** The Medical Claim Review Nurse provides support for medical claim review activities. Responsible for ensuring timely claims payment… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …ready to join a team that's redefining quality nursing care. The (RUN) Resource Utilization Nurse is primarily responsible for supporting the critical care units ... + Ongoing mentorship, _development,_ and leadership programs **Description** **Rapid Response Registered Nurse / RN** 7p-7:30a/ Full Time / 36 Hours per week Emory… more
- Evolent (Atlanta, GA)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Nurse Reviewer is responsible for performing precertification and prior approvals. Tasks are ... quality and cost effective care delivery. **What You'll Be Doing:** + Performs utilization review of outpatient procedures and ancillary services. + Fulfills on call… more
- Elevance Health (Atlanta, GA)
- …The **Telephonic Nurse Case Manager Senior** is responsible for care management within the scope of licensure for members with complex and chronic care ... **Telephonic Nurse Case Manager Senior** **Location:** This role enables...claims or service issues. + Assists with development of utilization /care management policies and procedures, chairs and… more
- Elevance Health (Atlanta, GA)
- …criteria._** The **Telephonic Nurse Case Manager II** is responsible for care management within the scope of licensure for members with complex and chronic care ... **Telephonic Nurse Case Manager II** **Location:** This role enables...claims or service issues. + Assists with development of utilization /care management policies and procedures. **Minimum requirements:**… more