- Elevance Health (Atlanta, GA)
- ** Nurse Appeals RN - Quality of Care** **Hybrid 1:** This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and ... Hours:** Monday-Friday, 8:00AM -5:00 PM Eastern Standard Time The ** Nurse Appeals ** is responsible for investigating and...and summarizes medical information for medical director. + Prepares nurse summaries for Quality of Care cases… more
- Molina Healthcare (Savannah, GA)
- **JOB DESCRIPTION** **Job Summary** The Clinical Appeals Nurse ( RN ) provides support for internal appeals clinical processes - ensuring that appeals ... provided to members. Contributes to overarching strategy to provide quality and cost-effective member care. Candidates with UM and...or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must… more
- Actalent (Atlanta, GA)
- …Service, Claims, Contracts and Benefits - Appeals , and Risk Management. Essential Skills + Registered Nurse ( RN ) with a valid license in GA or Compact. + ... Utilization Review - Registered Nurse Job Description This role...and benefit reviews, identifying patients for case management, conducting quality improvement reviews, and maintaining communication with various healthcare… more
- Humana (Atlanta, GA)
- …MRM, SRO **Use your skills to make an impact** **Required Qualifications** + Licensed Registered Nurse ( RN ) in the (appropriate state) with no disciplinary ... action. Humana is seeking a Part C Grievance & Appeals (G&A) Nurse who will assist in...need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families,… more
- Molina Healthcare (GA)
- …and/or coding experience, or equivalent combination of relevant education and experience. + Registered Nurse ( RN ). License must be active and unrestricted ... hours 6 AM to 6 PM (Team will work on set schedule) Looking for a RN with experience with appeals , claims review, and medical coding. **Job Summary** Provides… more
- Molina Healthcare (Savannah, 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 ... (Team will work on set schedule) Looking for a RN with experience with appeals , claims review,...or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must… more
- Molina Healthcare (Columbus, 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 for clinical...across the continuum. Contributes to overarching strategy to provide quality and cost-effective member care. The candidate must have… more