- Emory Healthcare/Emory University (Atlanta, GA)
- …+ Ongoing mentorship and leadership programs + And more! **Description** The **Registry Utilization Review Nurse ** (PRN) is responsible for conducting ... attending physician and/or physician advisor. + The UR RN (PRN) will perform utilization review by completing a timely and comprehensive review of all new… more
- CVS Health (Atlanta, GA)
- …all with heart, each and every day. **Position Summary** This Case Manager - Registered Nurse (RN) position is with Aetna's National Medical Excellence (NME) ... to apply, however, preference is for candidates in compact Registered Nurse (RN) states. This role is...is a blended role doing both Case Management and Utilization Management. The RN Case Manager is responsible for… more
- CVS Health (Atlanta, GA)
- …- Perform medical necessity reviews **Required Qualifications** - 5+ years' experience as a Registered Nurse with at least 1 year of experience in a hospital ... setting - A Registered Nurse that holds an active, unrestricted...lower levels of care - 1+ years' experience in Utilization Review - CCM and/or other URAC… more
- CVS Health (Atlanta, GA)
- …+ Perform medical necessity reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse with at least 1 year of experience in a hospital ... setting. + A Registered Nurse that holds an active, unrestricted...lower levels of care. + 1+ years' experience in Utilization Review . + CCM and/or other URAC… more
- Sharecare (Atlanta, GA)
- …cost effective, appropriate resource utilization and quality outcomes. The Clinical Registered Nurse is also responsible for early identification of those ... for everyone. To learn more, visit www.sharecare.com . **Job Summary:** The Clinical Registered Nurse has the responsibility for supporting the goals and… more
- Fresenius Medical Center (Lithonia, GA)
- …all FMS manuals. + Accountable for completion of the Annual Standing Order Review and ICD coding. + Checks correspondence whether electronic, paper or voice mail, ... supporting billing and collection activities. + Responsible for efficient utilization of medication, laboratory, inventory, supplies and equipment to achieve… more
- Evolent (Atlanta, GA)
- …Required and Preferred:** + Current, unrestricted state licensure as a Registered Nurse - **Required** + **California or Oregon License Required** ... , you will be a key member of the utilization management team. We can offer you a meaningful...+ Associate or Bachelors in Nursing (Must be a Registered Nurse ) - **Required** + You must… more
- Molina Healthcare (Atlanta, GA)
- …Managed Care Experience in the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and Support, ... outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical/medical reviews of previously denied cases… more
- CVS Health (Atlanta, GA)
- …inpatient, skilled nursing, or rehabilitative stay. Under the direction of a Registered /Licensed RN, the TOC Coach ensures the member experiences a seamless ... who cannot advocate for themselves. The TOC team will review prior claims to address potential impact on current...community. - Utilizes weekly and daily reporting to identify utilization for the purpose of reducing Emergency Department … more
- Molina Healthcare (Atlanta, GA)
- **JOB DESCRIPTION** Opportunity for experienced Utilization Review RN in United States who has a compact, multi-state license. This team reviews the prior ... requests for transplants; the ideal candidate will have experience either in utilization review or case management for transplants. Preference will be… more
- CenterWell (Duluth, GA)
- …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and ... delivery, and documentation requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking for performance … more
- Molina Healthcare (Atlanta, GA)
- …assurance, or recovery auditing, ideally in a DRG/ Clinical Validation * 3+ years of Utilization Review and/or Medical Claims Review experience. * 3+ years ... Training & Education **Preferred License, Certification, Association** Active and unrestricted Registered Nurse (RN) license and Certified Coding Specialist… more