• Utilization Management Nurse

    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 ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
    Humana (09/12/25)
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  • Utilization Management Nurse

    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 ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
    Humana (10/18/25)
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  • SNF Utilization Management RN…

    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 ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
    Humana (09/12/25)
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  • Clinical Registered Nurse

    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 and… more
    Cognizant (10/07/25)
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  • Consultant, Nurse Disability I

    Lincoln Financial (Atlanta, GA)
    …and/or proficiency with Disability Management (STD/LTD) knowledge, Workers Compensation, Utilization Review and/or nurse case management preferred skills ... Role at a Glance** We are excited to bring on a highly motivated Nurse Disability Consultant to our clinical organization. This position will be responsible for… more
    Lincoln Financial (10/10/25)
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  • Utilization Review Nurse Preceptor

    Emory Healthcare/Emory University (Decatur, GA)
    …development _,_ and leadership programs + And more **Description** We're seeking a **Clinical Utilization Review Nurse Preceptor (Registered Nurse / RN)** . ... This individual will be responsible for training, mentoring, and coaching for the Utilization Review Department and must be an expert in the utilization review… more
    Emory Healthcare/Emory University (10/02/25)
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  • Manager, Healthcare Services; Utilization

    Molina Healthcare (GA)
    …services professionals in some or all of the following functions: care management , utilization management , behavioral health, care transitions, long-term ... or more of the following activities: care review, care management , utilization management (prior authorizations,...experience. * At least 1 year of health care management /leadership experience. * Registered Nurse (RN), Licensed… more
    Molina Healthcare (09/19/25)
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  • Director, Healthcare Services; Utilization

    Molina Healthcare (GA)
    …of healthcare services professionals in some or all of the following functions: utilization management , care management , behavioral health and other ... of the following key health care services functions: care management , utilization management , care transitions,...and experience. * At least 3 years health care management /leadership required. * Registered Nurse (RN), Licensed… more
    Molina Healthcare (09/19/25)
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  • Associate Manager, Clinical Health Services…

    CVS Health (Atlanta, GA)
    …+ 5+ years of acute experience as a Registered Nurse + 3+ years of Utilization Management experience + 3+ year(s) of Appeals experience in Utilization ... members. **Position Summary** The Associate Manager is responsible for oversight of Utilization Management staff. This position is responsible for the… more
    CVS Health (10/15/25)
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  • Utilization Management

    Elevance Health (Atlanta, GA)
    ** Utilization Management Representative I** **Virtual:** This role enables associates to work virtually full-time, with the exception of required in-person ... an accommodation is granted as required by law._ The ** Utilization Management Representative I** will be responsible...requests. + Refers cases requiring clinical review to a Nurse reviewer. + Responsible for the identification and data… more
    Elevance Health (10/14/25)
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  • Utilization Management Rep I (US)

    Elevance Health (Atlanta, GA)
    ** Utilization Management Representative I** **Virtual:** This role enables associates to work virtually full-time, with the exception of required in-person ... an accommodation is granted as required by law._ The ** Utilization Management Representative I** will be responsible...requests. + Refers cases requiring clinical review to a Nurse reviewer. + Responsible for the identification and data… more
    Elevance Health (10/11/25)
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  • Utilization Review Clinician - Behavioral…

    Centene Corporation (Atlanta, GA)
    …hours.** **The ideal candidate will have experience in behavioral health utilization management .** **Education/Experience:** Requires Graduate of an Accredited ... 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive… more
    Centene Corporation (10/10/25)
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  • Medical Management Nurse (US)

    Elevance Health (Atlanta, GA)
    **Medical Management Nurse ** **Location: Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training ... members in different states; therefore, Multi-State Licensure will be required.** The **Medical Management Nurse ** is responsible for review of the most complex… more
    Elevance Health (10/17/25)
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  • Medical Management Nurse

    Elevance Health (Atlanta, GA)
    **Medical Management Nurse ** **Location: Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training ... members in different states; therefore, Multi-State Licensure will be required.** The **Medical Management Nurse ** is responsible for review of the most complex… more
    Elevance Health (10/16/25)
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  • Licensed Practical Nurse (LPN/LVN) -…

    STG International (Milledgeville, GA)
    …FUNCTIONS: + Ensure the facility meets the minimum staffing levels for nurses and nurse aides; complete required posting of nursing staff data as required. + Ensure ... and education for self-help as appropriate. + Provide pain management for residents in accordance with established pain ...+ Coordinate with the scheduler to ensure a Registered Nurse (RN) is on duty at least 8 hours… more
    STG International (07/24/25)
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  • Case Manager, Registered Nurse - Fully…

    CVS Health (Atlanta, GA)
    …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... Abuse or Maternity/ Obstetrics experience. **Preferred Qualifications** + 1+ years' Case Management experience or discharge planning, nurse navigator or nurse more
    CVS Health (10/18/25)
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  • Nurse Practitioner, Cardiology

    ChenMed (Decatur, GA)
    management programs, clinical meetings and other meetings. The Nurse Practitioner, Specialty incumbent adheres to strict departmental goals/objectives, standards ... we need great people to join our team. The Nurse Practitioner (NP), Specialty acts as part of the...nursing plan of care, health education, physician referrals, case management referrals, follow-up and clear documentation according to ChenMed… more
    ChenMed (09/26/25)
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  • Nurse Practitioner

    ChenMed (Morrow, GA)
    management programs, clinical meetings and other meetings. The Nurse Practitioner will adhere to strict departmental goals/objectives, standards of performance, ... we need great people to join our team. The Nurse Practitioner (NP) acts as part of the clinical...nursing plan of care, health education, physician referrals, case management referrals, follow-up and clear documentation according to ChenMed… more
    ChenMed (09/25/25)
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  • Field Nurse Practitioner (Boise, ID)

    Molina Healthcare (Macon, GA)
    **JOB DESCRIPTION** **Job Summary** The Care Connections Nurse Practitioners focus on screening and preventive primary care services delivered in the home, ... are most receptive including home, nursing facilities, and "pop up" clinic. The Nurse Practitioner will be required to work primarily in non-clinical settings and… more
    Molina Healthcare (10/16/25)
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  • Field Nurse Practitioner (Pocatello, ID)

    Molina Healthcare (GA)
    …post-discharge coordination to reduce hospital readmission rates and emergency room utilization . * Performs face-to-face in-person visits in a variety of settings ... states besides home state based on business need. * Collaborates with fellow nurse practitioners to develop best practices to perform work duties efficiently and… more
    Molina Healthcare (10/17/25)
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