- Emory Healthcare/Emory University (Atlanta, GA)
- …mentorship, _development,_ and leadership programs + And more **Description** We're seeking an ** Inpatient Registry Utilization Review Nurse (PRN)** who is ... physician and/or physician advisor. This individual will: + Perform utilization review by completing a timely and... review by completing a timely and comprehensive review of all new observation and inpatient … more
- Cognizant (Atlanta, GA)
- …Monday to Friday - Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced level work related to ... as well as timely filing deadlines and processes. . Review clinical denials including but not limited to referral,...to have to be considered** . Educational background - Registered Nurse (RN) . 2-3 years combined clinical and/or… more
- Molina Healthcare (Atlanta, GA)
- …* At least 2 years experience, including experience in hospital acute care, inpatient review , prior authorization, managed care, or equivalent combination of ... JOB DESCRIPTION Job SummaryProvides support for clinical member services review assessment processes. Responsible for verifying that services are...relevant education and experience. * Registered Nurse (RN). License must be active and unrestricted… more
- CVS Health (Atlanta, GA)
- …critical thinking and evidence-based clinical criteria to evaluate outpatient and inpatient services requiring precertification and concurrent review . + Conduct ... are not permitted. **Required Qualifications** + Active unrestricted state Registered Nurse licensure in state of residence required. +...experience in Nursing. + At least 1 year of Utilization Management experience in concurrent review or… more
- Molina Healthcare (Atlanta, GA)
- …experience, preferably in a hospital setting, including at least 1 year of utilization review , medical claims review , claims auditing, medical necessity ... claim review including diagnosis-related group (DRG) validation, itemized bill review , appropriate level of care, inpatient readmission, and any opportunity… more
- Molina Healthcare (Atlanta, GA)
- …* At least 2 years experience, including experience in hospital acute care, inpatient review , prior authorization, managed care, or equivalent combination of ... relevant education and experience. * Registered Nurse (RN). License must be active and unrestricted...in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management… more
- Molina Healthcare (Atlanta, GA)
- …SKILLS & ABILITIES:** + Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years ... Assists with Complex Claim review including DRG Validation, Itemized Bill Review , Appropriate Level of Care, Inpatient Readmission, and any opportunity… more