- Molina Healthcare (GA)
- … decisions for appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse ( RN ) performs clinical ... **JOB DESCRIPTION** **Job Summary** Clinical Appeals is responsible for making...these guidelines. **Required License, Certification, Association** Active, unrestricted State Registered Nursing ( RN ) license in good standing.… more
- Cognizant (Atlanta, GA)
- …have to be considered** . Educational background - Registered Nurse ( RN ) . 2-3 years combined clinical and utilization management experience with managed ... Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact...clinic operations . Experience in utilization management to include Clinical Appeals and Grievances, precertification, initial and… more
- Elevance Health (Atlanta, GA)
- ** Nurse Appeals ** **Hybrid 1:** This role.../grievances/quality of care issues and is a resource for clinical and non clinical team members in ... an accommodation is granted as required by law._ The ** Nurse Appeals ** is responsible for investigating and...would provide an equivalent background. + Current active unrestricted RN license to practice as a health professional within… more
- Evolent (Atlanta, GA)
- …to Standard processing, documenting accordingly. + Works closely with the appeals -dedicated Clinical Reviewers to ensure timely adjudication of processed ... for the culture. **What You'll Be Doing:** The Specialty Appeals Team offers candidates the opportunity to make a...and Preferred:** + 1-3 years' experience and as an RN - **Required** + Minimum of 5 years in… more
- Molina Healthcare (Columbus, GA)
- …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** Utilizing ... resource for Utilization Management, Chief Medical Officers, Physicians, and Member/Provider Inquiries/ Appeals . + Provides training and support to clinical … more
- CVS Health (Atlanta, GA)
- …licensure in non-compact states as needed. + 5+ years of acute experience as a Registered Nurse + 3+ years of Utilization Management experience + 3+ year(s) of ... Managers, Manager, and other key stakeholders such as Medical Directors, account teams/ clinical liaisons, etc.) to ensure consistency in clinical interventions… more
- Morehouse School Of Medicine (Atlanta, GA)
- …issues . Current knowledge of institutional and programmatic accreditation requirements for nurse -midwifery, nurse practitioner, and RN educational programs ... directly to the Senior Associate Dean and Chief of Clinical & Academic Education, the Chair will collaborate closely...accredited institution of higher education . Active, unencumbered Georgia RN license and midwifery or APRN license . Current… more