- Actalent (Atlanta, GA)
- Utilization Review - Registered Nurse Job Description This role involves performing precertification and medical necessity reviews for designated ... Benefits - Appeals, and Risk Management. Essential Skills + Registered Nurse (RN) with a valid license...+ Experience with MCG or Interqual is preferred. + Utilization review experience is a plus. Job… more
- Emory Healthcare/Emory University (Decatur, GA)
- …_,_ and leadership programs + And more **Description** We're seeking a **Clinical Utilization Review Nurse Preceptor ( Registered Nurse / RN)** . This ... individual will be responsible for training, mentoring, and coaching for the Utilization Review Department and must be an expert in the utilization review… 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 ... to have to be considered** . Educational background - Registered Nurse (RN) . 2-3 years combined...Nurse (RN) . 2-3 years combined clinical and/or utilization management experience with managed health care plan .… more
- Humana (Atlanta, GA)
- …SRO **Use your skills to make an impact** **Required Qualifications** + Licensed Registered Nurse (RN) in the (appropriate state) with no disciplinary action ... caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing...who will assist in preparation of cases prior to review by the Humana G&A Medicare Medical Directors. The… 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 ... perspective on workplace flexibility. **Position Purpose:** Performs a clinical review and assesses care related to mental health and...Mental Health Professional (LMHP) required or + RN - Registered Nurse - State Licensure and/or Compact… more
- Humana (Atlanta, GA)
- …impact** **Use your skills to make an impact** **Required Qualifications** + **Licensed Registered Nurse (RN)** in the (appropriate state) with no disciplinary ... caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing...in an acute care setting + Previous experience in utilization management/ utilization review for a… more
- Molina Healthcare (Atlanta, GA)
- …At least 2 years clinical nursing experience, including at least 1 year of utilization review , medical claims review , long-term services and supports (LTSS), ... Looking for a RN with experience with appeals, claims review , and medical coding. **Job Summary** Provides support for...or equivalent combination of relevant education and experience. + Registered Nurse (RN). License must be active… more
- Fresenius Medical Center (Newnan, GA)
- …auditing activities. + Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. + Manages clinic ... financials including efficient utilization of supplies or equipment and regular profits and...of supplies or equipment and regular profits and loss review . + Responsible for all required network reporting and… more
- Humana (Atlanta, GA)
- …timeframe **Use your skills to make an impact** **Required Qualifications** + Licensed Registered Nurse (RN) Compact license, with no disciplinary action + 3 ... caring community and help us put health first** The Utilization Management Behavioral Health Nurse 2 utilizes...Complete medical record reviews + Assess discharge plans + Review and extract information from claims + Complete documentation… 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 services and supports ... health, pharmacy, etc.), or equivalent combination of relevant education and experience. * Registered Nurse (RN). License must be active and unrestricted in… more
- Humana (Atlanta, GA)
- …**Use your skills to make an impact** **Required Qualifications** + **Active Registered Nurse (RN) Multi-state/Compact State license with no disciplinary ... caring community and help us put health first** The Nurse Advice Line is a fast-paced inbound call center...Bachelor's degree in nursing (BSN) + Previous case management, utilization review , or triage experience + Previous… more
- Sharecare (Atlanta, GA)
- …to enable individuals with disabilities to perform the essential functions. + Current Registered Nurse multi-state compact license in the state in which they ... utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during their interactions with participants for identification… more
- Molina Healthcare (Atlanta, GA)
- …authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse (RN). License must be active and unrestricted in ... unit (ICU) or emergency room. Previous experience in managed care Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG… more
- Molina Healthcare (Atlanta, GA)
- For this position we are seeking a (RN) Registered Nurse who must be licensed for the state they reside This role will be doing Utilization review for ... authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse (RN). License must be active and unrestricted in… more
- Molina Healthcare (Atlanta, GA)
- …internal meetings. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse (RN). **Required Experience** 1-3 years of hospital ... Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual… more
- Molina Healthcare (Atlanta, GA)
- For this position we are seeking a (RN) Registered Nurse who must hold a compact license. This is a Remote position, home office with internet connectivity of ... Looking for a RN with experience with appeals, claims review , and medical coding. JOB DESCRIPTION Job SummaryProvides support...or equivalent combination of relevant education and experience. * Registered Nurse (RN). License must be active… more
- Molina Healthcare (Atlanta, GA)
- …authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse (RN). License must be active and unrestricted in ... JOB DESCRIPTION **Job Summary** The RN Care Review Clinician provides support for clinical member services...member care. The candidate must have Medicare Appeals and/or Utilization Management knowledge. Work hours are Monday-Friday 8:00am- 5:00pm… more
- Molina Healthcare (Atlanta, GA)
- …authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse (RN). License must be active and unrestricted in ... JOB DESCRIPTION **Job Summary** The Care Review Clinician (RN) provides support for clinical member...to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. **Required Qualifications** *… more
- Molina Healthcare (Atlanta, GA)
- …authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse (RN). License must be active and unrestricted in ... JOB DESCRIPTION Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically… more
- CenterWell (Marietta, GA)
- …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and ... requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking...School of Nursing. + Current state license as a Registered Nurse . + Proof of current CPR.… more