- Humana (Atlanta, GA)
- …where your clinical expertise and passion for accuracy will make a meaningful impact. As the Nurse Audit Manager , you will spearhead audit and validation ... relevant coding. + Identifies the root cause analysis of audit findings and submits recommendations for appropriate change management....skills to make an impact** **Required Qualifications** + Registered nurse (RN). + 5 or more years of clinical… more
- Elevance Health (GA)
- ** Nurse Case Manager Senior - Field Nurse ** **Work location:** This field-based role located in the Albany, GA area enables associates to primarily operate ... 1 late evening shift 11:00am to 7:30pm EST. The ** Nurse Case Manager Senior - Field ...for new care management staff. + Participates in department audit activities. **Minimum requirements:** + Requires BA/BS in a… more
- Elevance Health (Atlanta, GA)
- **Telephonic Nurse Case Manager Senior** **Location:** This role enables associates to work virtually full-time, with the exception of required in-person ... in different states; therefore, Multi-State Licensure will be required.** The **Telephonic Nurse Case Manager Senior** is responsible for care management within… more
- Elevance Health (Atlanta, GA)
- The ** Nurse Case Manager ** **Lead** is responsible for care management within the scope of licensure for members with complex and chronic care needs by ... and functions as preceptor for new care management staff. + Participates in audit activities and assists supervisor with management of day-to-day activities, such as… more
- Elevance Health (Atlanta, GA)
- …Monday - Friday, 9am - 5:30pm (4 days) 11:30am - 8pm (1 day) EST** The ** Nurse Case Manager Senior** is responsible for care management within the scope of ... functions as preceptor for new care management staff. Participates in department audit activities. Position Requirements: + Requires BA/BS in a health related field… more
- Molina Healthcare (GA)
- …programs. **Preferred Qualifications** * Certified Clinical Coder (CCC), Certified Medical Audit Specialist (CMAS), Certified Case Manager (CCM), Certified ... JOB DESCRIPTION **Job Summary** The Medical Claim Review Nurse provides support for medical claim review activities....Candidates with knowledge of CPT/HCPCS codes, record review, chart audit , provider disputes, appeals, and 1500 & UB04 claim… more
- Molina Healthcare (Columbus, GA)
- …**PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:** Certified Clinical Coder, Certified Medical Audit Specialists, Certified Case Manager , Certified Professional ... to clinical experience + Documents clinical review summaries, bill audit findings and audit details in the database + Provides supporting documentation for… more
- Molina Healthcare (GA)
- …Oversees interdisciplinary care team (ICT) meetings. * Functions as hands-on manager responsible for supervision and coordination of daily integrated healthcare ... and triage activities. * Ensures completion of staff quality audit reviews; evaluates services provided, outcomes achieved and recommends enhancements/improvements… more
- CVS Health (Atlanta, GA)
- …travel if a plan sponsor requests pharmacist attendance for an onsite visit/assessment/ audit . The Pharmacy Program Manager role includes: -Collaborate with an ... with heart, each and every day. The Pharmacy Program Manager is an individual contributor (non-people manager )...interdisciplinary care management team ( nurse case managers, medical directors, dietitians, social workers) to… more
- Elevance Health (Atlanta, GA)
- …coding principles, clinical guidelines, and objectivity in the performance of medical audit activities. + Draws on advanced ICD-10 coding expertise, mastery of ... clinical guidelines, and industry knowledge to substantiate conclusions. + Utilizes audit tools, auditing workflow systems and reference information to generate … more
- Stantec (Atlanta, GA)
- …work requirements and initiate appropriate measures with assigned project manager to facilitate project completion. - Maintain schedules, ensuring proper ... resources are allocated to each commissioning task. - Audit all sites during commissioning to ensure desired scope,...Qualifications and Experience - CEM or EMIT (Certified Energy Manager or Energy Manager in Training). -… more
- CenterWell (Savannah, GA)
- …intent Overseeing other clinicians which includes Physicians, Advanced Registered Nurse Practitioners (ARNP), and Physicians Assistants (PA) in: + Maintaining ... and complaints from patients + Ongoing chart review / audit of clinical staff to ensure quality care and...of home health services, and fourth largest pharmacy benefit manager , CenterWell is focused on whole-person health by addressing… more
- Herc Rentals (Ellenwood, GA)
- …communicate effectively and professionally with our customers + Satisfy and audit , in a timely manner, all required documentation, timesheets, checklists, receiving ... Flex spending and health savings accounts Virtual Health Visits 24 Hour Nurse Line Healthy Pregnancy Program Tobacco Cessation Program Weight Loss Program **Building… more