- Molina Healthcare (Atlanta, GA)
- … and/or coding experience, or equivalent combination of relevant education and experience. + Registered Nurse ( RN ). License must be active and unrestricted ... 6 PM (Team will work on set schedule) Looking for a RN with experience with appeals, claims review , and medical coding. **Job Summary** Provides support for … more
- Fresenius Medical Center (Newnan, GA)
- …- 745 Poplar Rd. Newnan, GA 30265** **PURPOSE AND SCOPE:** The Inpatient RN provides direct patient care in accordance to company policies and procedures which ... dialysis, continuous renal replacement therapies, apheresis, and ultrafiltration. The Inpatient RN will partner with the hospital to provide quality care to… more
- Fresenius Medical Center (Newnan, GA)
- **About this role:** As a Clinical Manager with Fresenius Medical Care, you will ensure that quality patient care is delivered while maintaining clinical operations. ... a tremendous asset that sets us apart. At Fresenius Medical Care, you will truly make a difference in...+ Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. +… more
- Actalent (Atlanta, GA)
- Utilization Review - Registered Nurse Job...Benefits - Appeals, and Risk Management. Essential Skills + Registered Nurse ( RN ) with a valid ... Description This role involves performing precertification and medical necessity reviews for designated referrals and targeted outpatient procedures, services, and… more
- Cognizant (Atlanta, GA)
- …expectations. **What you need to have to be considered** . Educational background - Registered Nurse ( RN ) . 2-3 years combined clinical and/or utilization ... Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact...the medical necessity determinations to the Health Plan/ Medical Director based on the review of… more
- Vatica Health (Atlanta, GA)
- …+ Minimum of 3 years of recent adult health clinical experience as a Registered Nurse ( RN )- preferably in critical care (ie, ICU/CCU/MICU) and/or ... Are you an RN looking for a career opportunity in healthcare...and detailed-oriented nurses to join our team. As a Nurse Consultant, you will collect, review and… more
- PruittHealth (Union City, GA)
- …care or LTC experience. **MINIMUM LICENSURE/CERTIFICATION REQUIRED BY LAW:** Current and unrestricted Registered Nurse ( RN ) licensure in state of practice. ... staff's demonstration of proper procedures and attitudes and reviewing medical records and documentation. **KEY RESPONSIBILITIES:** 1. Coordinates clinical… more
- Elevance Health (Atlanta, GA)
- **Clinical Fraud Investigator II - Registered Nurse and CPC - Calrelon Payment Integrity SIU** **Location:** This role requires associates to be in-office 1 - 2 ... opportunities for fraud and abuse prevention and control. + Review and conducts analysis of claims and medical...Skills, Qualifications, and Experiences:** + Fraud and Abuse experienced Nurse with a CPC are highly desired. For candidates… more
- Prime Healthcare (Riverdale, GA)
- …Connect With Us! (https://careers-primehealthcare.icims.com/jobs/230280/case-manager- registered - nurse /job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) ... outcomes and to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity, intensity of service… more
- Elevance Health (Atlanta, GA)
- …states; therefore, Multi-State Licensure will be required.** The ** Medical Management Nurse ** is responsible for review of the most complex or challenging ... ** Medical Management Nurse ** **Location: Virtual: This...Skills and Experiences:** + ACMP experience is preferred. + Medical Management experience is preferred, + Utilization Review… more
- Elevance Health (Atlanta, GA)
- …states; therefore, Multi-State Licensure will be required.** The ** Medical Management Nurse ** is responsible for review of the most complex or challenging ... ** Medical Management Nurse ** **Location Virtual: This...in multiple states. **Preferred Capabilities, Skills and Experiences:** + Medical Management experience is preferred, + Utilization Review… more
- Molina Healthcare (Atlanta, GA)
- …health, pharmacy, etc.), or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... **JOB DESCRIPTION** **Job Summary** The Clinical Appeals Nurse ( RN ) provides support for internal...specific programs supported by the plan such as utilization review , medical claims review , long-term… more
- BioLife Plasma Services (Morrow, GA)
- …requirements Currently licensed or certified in the state where responsibilities will be assigned: Registered Nurse ( RN ), Nurse Practitioner (NP) or ... the Plasma Center Manager and will perform as a Medical Support Specialist (Plasma Center Nurse ) to...eligibility to donate plasma, management of donor adverse events, review of laboratory test results, and donor notification of… more
- Humana (Atlanta, GA)
- …concerns.** **Use your skills to make an impact** **Required Qualifications** + **Active Registered Nurse ( RN ) Multi-state/Compact State license with no ... needs at the discretion of department leadership. The Telephonic Nurse provides medical guidance, assists with access...degree in nursing (BSN) + Previous case management, utilization review , or triage experience + Previous experience in a… 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 ... a RN with experience with appeals, claims review , and medical coding. JOB DESCRIPTION Job...or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must… 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… 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 ... JOB DESCRIPTION **Job Summary** The RN Care Review Clinician provides support...care unit, or in a telemetry type setting. UM medical review experience highly preferred. Work Hours:… more
- Dialysis Clinic, Inc. (Fayetteville, GA)
- …experience; experience preferred **Benefits:** + Paid training with preceptor + Charge nurse continuing education classes + Comprehensive medical , dental and ... to physician; implement and document orders + Participate in patient care conferences, medical rounds and chart review ; document progress notes + Contribute to… 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 ... JOB DESCRIPTION **Job Summary** The Care Review Clinician ( RN ) provides support for...requests within required timelines. * Refers appropriate cases to medical directors (MDs) and presents them in a consistent… more
- Elevance Health (Atlanta, GA)
- ** Nurse Appeals RN -Quality of Care** **Hybrid...summaries for Quality of Care cases and forwards to Medical Director for review and determination. + ... **Expected Work Hours:** Monday-Friday, 8:00AM -5:00 PM Eastern Standard Time The ** Nurse Appeals** is responsible for investigating and processing and medical … more