- 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 ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...action. Humana is seeking a Part C Grievance & Appeals (G&A) Nurse who will assist in… more
- Molina Healthcare (Savannah, GA)
- …be required. * Serves as a clinical resource for utilization management , chief medical officer, physicians, and member/provider inquiries/ appeals . * Provides ... **JOB DESCRIPTION** **Job Summary** The Clinical Appeals Nurse (RN) provides support for...officer on denial decisions. * Resolves escalated complaints regarding utilization management and long-term services and supports… more
- CVS Health (Atlanta, GA)
- …with heart, each and every day. **Position Summary** CVS Aetna is seeking a dedicated ** Appeals Nurse Consultant** to join our remote team. In this role, you ... in state of residence. + 3+ years clinical experience. **Preferred Qualifications** + Appeals , Managed Care, or Utilization Review experience. + Proficiency with… more
- Cognizant (Atlanta, GA)
- …background - Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management experience with managed health care plan . 3 years' experience ... Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced...care revenue cycle or clinic operations . Experience in utilization management to include Clinical Appeals… more
- Actalent (Atlanta, GA)
- …providers, Customer Service, Claims, Contracts and Benefits - Appeals , and Risk Management . Essential Skills + Registered Nurse (RN) with a valid license in ... Utilization Review - Registered Nurse Job...GA or Compact. + 1+ years of experience in Utilization Management (UM). + 1+ years of...+ 1+ years of experience in Utilization Management (UM). + 1+ years of experience in managed… more
- Molina Healthcare (GA)
- …decisions. + Serves as a clinical resource for utilization management , CMOs, physicians and member/provider inquiries/ appeals . + Provides training and ... ensure appropriate reimbursement to providers. + Resolves escalated complaints regarding utilization management and long-term services and supports (LTSS)… more
- Molina Healthcare (Macon, GA)
- …of health care services provided to plan members. * Supports plan utilization management program and accompanying action plan(s), which includes strategies ... the most appropriate care at the most effective setting. *Evaluates effectiveness of utilization management (UM) practices - actively monitoring for over and… more
- Molina Healthcare (Atlanta, GA)
- … and effective resource management . + Develops and implements a Utilization Management program and action plan, which includes strategies that ensure ... + Participates in and maintains the integrity of the appeals process, both internally and externally. Responsible for the...analysts to produce tools to report, monitor and improve Utilization Management . + Actively participates in regulatory,… more
- Elevance Health (Atlanta, GA)
- **Clinical Operations Medical Director** **Medical Oncology** **Carelon Medical Benefit Management ** **Virtual** : This role enables associates to work virtually ... proud member of the Elevance Health family of companies, Carelon Medical Benefits Management , formerly AIM Specialty Health, is a benefit- management leader in… more
- Molina Healthcare (Columbus, GA)
- …to provide quality and cost-effective member care. The candidate must have Medicare Appeals and/or Utilization Management knowledge. Work hours are ... to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. **Required...equivalent combination of relevant education and experience. * Registered Nurse (RN). License must be active and unrestricted in… more
- Molina Healthcare (Savannah, GA)
- …with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications * At ... For this position we are seeking a (RN) Registered Nurse who must hold a compact license. This is...set schedule) Looking for a RN with experience with appeals , claims review, and medical coding. JOB DESCRIPTION Job… more