- 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 ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...appropriate courses of action. As a Utilization Management RN working on the OneHome/ Home Solutions… more
- 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 (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
- AdventHealth (Calhoun, GA)
- …Whitfield, Catoosa and Murray or Floyd and Bartow. **The role you'll contribute:** The Home Health Registered Nurse (RN) Care Manager is a professional nurse ... needs. The RN Care Manager is responsible for independent management of the Home Health patient population...implementation and evaluation for that caseload as the primary nurse . Sets priorities of home care caseload… more
- Molina Healthcare (Macon, GA)
- …receptive including home , nursing facilities, and "pop up" clinic. The Nurse Practitioner will be required to work primarily in non-clinical settings and provide ... 3-5-year experience as a Registered Nurse and/or Nurse Practitioner, ideally in a home health,...home health as a licensed clinician, especially in management of chronic conditions + Experience with underserved populations… more
- STG International (Milledgeville, GA)
- STGi is seeking a LPN/LVN to provide services at our Georgia War Veterans Home . If you have compassion and a passion to care for Veterans, this could be the job for ... facility meets the minimum staffing levels for nurses and nurse aides; complete required posting of nursing staff data...and education for self-help as appropriate. + Provide pain management for residents in accordance with established pain … more
- Molina Healthcare (GA)
- …(EMR) experience. Preferred Qualifications * Experience as a registered nurse or nurse practitioner in a home health, community health or public health ... in home health as a licensed clinician, especially in management of chronic conditions. * Experience with underserved populations facing socioeconomic barriers… more
- 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
- 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...medical centers, nursing homes, skilled nursing facilities (SNF) and home settings depending on the nature of the assignment… more
- 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...care in nursing homes, skilled nursing facilities (SNF) and home settings, or supporting a Cardiologist practice. The responsibilities… more
- Elevance Health (GA)
- …shift 11:00am to 7:30pm EST. The ** Nurse Case Manager Senior - Field Nurse ** is responsible for care management within the scope of licensure for members ... equity and promote culturally responsive care. + Assists with development of utilization /care management policies and procedures, chairs and schedules meetings,… more
- Molina Healthcare (GA)
- …Chief Medical Officer on denial decisions. + Resolves escalated complaints regarding Utilization Management and Long-Term Services & Supports issues. + ... as may be required. + Serves as a clinical resource for Utilization Management , Chief Medical Officer, Physicians, and Member/Provider Inquiries/Appeals. +… more
- Lincoln Financial (Atlanta, GA)
- …and/or proficiency with Disability Management (STD/LTD) knowledge, Workers Compensation, Utilization Review and/or nurse case management preferred skills ... **Alternate Locations:** Work from Home **Work Arrangement:** Remote : Work at ...We are excited to bring on a highly motivated Nurse Disability Consultant to our clinical organization. This position… more
- Evolent (Atlanta, GA)
- …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and ... Be Doing:** + Practices and maintains the principles of utilization management and appeals management ...all employees have the following technical capability at their home : High speed internet over 10 Mbps and, specifically… more
- Emory Healthcare/Emory University (Duluth, GA)
- …review of medical necessity for all inpatients, concurrent stay documentation per utilization management plan, verification and correction of patient status, ... educational opportunities to enhance health care teams knowledge of case management services; + Participates in and facilitates patient/family education and… more
- US Tech Solutions (GA)
- …is a remote position and requires the ability to effectively support a work from home environment. Must have the ability to work in a HIPAA compliant work area away ... is necessary and will involve computer system data entry, data management , and reporting. + Review criteria-based prior authorizations following policy and… more
- Fresenius Medical Center (Albany, GA)
- …and acting on adverse events and action thresholds. + Oversees facility's Home Therapies Program if applicable. + Accountable for compliance with all applicable ... and acts as the liaison for patient care as per the disease management agreement, including initial and ongoing validation of member eligibility. Facilitate timely… more
- Fresenius Medical Center (Vidalia, GA)
- …Quality, and Technical Services departments. + Collaborates with or functions as the Home Therapies Program Manager to oversee the facility's Home Therapies ... Classification of Disease (ICD) coding. + Manages clinic financials including efficient utilization of supplies or equipment and regular profits and loss review. +… more
- CenterWell (Decatur, GA)
- …+ Two years as a Registered Nurse with at least one-year of management experience in a home care, hospice or equivalent environment. + Home ... community and help us put health first** Reports To: Associate Director, Home Health Branch Administrator FLSA: Exempt **Work Schedule** : Full-time/40 Hours… more
- Molina Healthcare (Atlanta, GA)
- … and effective resource management . + Develops and implements a Utilization Management program and action plan, which includes strategies that ensure ... IT and data analysts to produce tools to report, monitor and improve Utilization Management . + Actively participates in regulatory, professional and community… more