- Cognizant (Atlanta, GA)
- …you need to have to be considered** . Educational background - Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management ... Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact...care revenue cycle or clinic operations . Experience in utilization management to include Clinical Appeals and… 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)** . ... clinical expert, leader, and role model within the Utilization Review Department as it relates to the understanding...Will demonstrate foresight regarding the impact of both the clinical and administrative roles within the utilization … more
- 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 ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are...+ Minimum of Associate Degree in nursing + Licensed Registered Nurse (RN) in a compact state… more
- Humana (Atlanta, GA)
- …a part of our caring community and help us put health first** The Weekend Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... Communities is good for the Soul. Join Us!** The Utilization Management Nurse 2 uses clinical...skills to make an impact** **Required Qualifications** + Licensed Registered Nurse (RN) in the (appropriate state)… more
- Community Health Systems (Statesboro, GA)
- …for addressing unit challenges and emergencies. **Licenses and Certifications** + RN - Registered Nurse - State Licensure and/or Compact State Licensure required ... huddles. + Monitors patient flow, manages bed assignments, and optimizes resource utilization within the unit. + Conducts employee and patient rounding to evaluate… more
- CVS Health (Atlanta, GA)
- …non-compact states as needed. + 5+ years of acute experience as a Registered Nurse + 3+ years of Utilization Management experience + 3+ year(s) of Appeals ... of utilization management services for assigned area + Implements clinical policies & procedures in accordance with applicable regulatory and accreditation… more
- Fresenius Medical Center (Albany, GA)
- …requirements. Ensure provision of quality patient care while maintaining cost-effective clinical operations in accordance with all legal, compliance, and regulatory ... FMCNA Compliance Program, and FMS patient care and administrative policies as the clinical leader, has the authority to make daily decisions to ensure continuity of… more
- Fresenius Medical Center (Vidalia, GA)
- **About this role:** As a Clinical Manager with Fresenius Medical Care, you will ensure that quality patient care is delivered while maintaining clinical ... or chronic kidney disease. **Training and advancement:** You will enter our Clinical Leadership Program that creates and supports a culture of continuous learning… more
- Fresenius Medical Center (Bremen, GA)
- …+ Participates in cost control initiatives. Responsible for efficient utilization of medication, laboratory, inventory, supplies and equipment to achieve ... supply cost goals following all guidelines established in the formularies. + Assists in the development and revision of any applicable policies and procedures for the facility as directed to ensure continuous process improvement. + Initiates, documents and… 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 ... is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that...setting. + A Registered Nurse that holds an active, unrestricted… more
- Molina Healthcare (GA)
- …experience. * At least 1 year of health care management/leadership experience. * Registered Nurse (RN), Licensed Vocational Nurse (LVN), Licensed Practical ... Nurse (LPN), Licensed Clinical Social Worker (LCSW), Licensed Marriage and Family Therapist...Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications * Registered Nurse (RN). License must be active… more
- Molina Healthcare (GA)
- …and experience. * At least 3 years health care management/leadership required. * Registered Nurse (RN), Licensed Vocational Nurse (LVN), Licensed Practical ... Nurse (LPN), Licensed Clinical Social Worker (LCSW), Licensed Marriage and Family Therapist...Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications * Registered Nurse (RN). License must be active… 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 ... independent determination of the appropriate courses of action. The Utilization Management Nurse 2 uses clinical...skills to make an impact** **Required Qualifications** + **Licensed Registered Nurse (RN)** in the (appropriate state)… more
- AdventHealth (Calhoun, GA)
- …Catoosa and Murray or Floyd and Bartow. **The role you'll contribute:** The Home Health Registered Nurse (RN) Care Manager is a professional nurse who ... requiring the use of advanced assessment, teaching and decision-making skills. The nurse is responsible for ensuring that appropriate referrals to other services are… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …programs + And more **Description** We're seeking an **Bed Planning Coordinator Registered Nurse ** provides 24/7 coverage for the Capacity Command Center. ... for all EHC operating units, coordinating room assignments to optimize bed utilization across the health system, critically thinking to manage appropriate patient… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …leadership programs + And more **Description** We're seeking an **Transfer Center Registered Nurse is** responsible for accepting incoming referral information ... indvidual: + Coordinates, prioritizes, and optimizes patient flow using knowledge of clinical and operational activities throughout the hospital network. + Collects … more
- Emory Healthcare/Emory University (Duluth, GA)
- …across a continuum; ensuring and facilitating the achievement of quality clinical and cost outcomes; negotiating, procuring and coordinating appropriate services and ... + Serves as an internal resource regarding reimbursement and clinical practice issues; + Serves as a coach, mentor...barriers to the progression of care. + Applies approved utilization acuity criteria (Interqual or MCG Guidelines) to monitor… more
- Molina Healthcare (GA)
- …decisions for appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical /medical ... Officer during Fair Hearings as may be required. + Serves as a clinical resource for Utilization Management, Chief Medical Officer, Physicians, and… more
- Centene Corporation (Atlanta, GA)
- …required or + Licensed Mental Health Professional (LMHP) required or + RN - Registered Nurse - State Licensure and/or Compact State Licensure required Pay Range: ... the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified,… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …who will function as a liaison between the blood bank and clinical staff, utilizing tools such as audits, quality improvement activities, educational presentations, ... will be responsible for the following job duties: + Clinical Collaboration & Support + 1. Collaborate with all...revision of policies related to blood administration, consent, and utilization guidelines. + Education & Training + 1. Provide… more