- Molina Healthcare (Atlanta, GA)
- …**Preferred Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of ... compliance with all state and federal regulations and guidelines. + Analyzes clinical service requests from members or providers against evidence based clinical… more
- Elevance Health (Atlanta, GA)
- ** Clinical Fraud Investigator II - Registered Nurse and CPC - Calrelon Payment Integrity SIU** **Location:** This role requires associates to be in-office 1 - 2 ... to recover, eliminate and prevent unnecessary medical-expense spending. The ** Clinical Fraud Investigator II** is responsible for identifying issues and/or… more
- Veterans Affairs, Veterans Health Administration (Atlanta, GA)
- …a bachelor's level degree in Nursing may have opportunity to become registered as a nurse with a state licensing board prior to completion of the bridge program. ... determined by the VHA Edu. Loan Repayment Services program office after review of the EDRP application. Former EDRP participants ineligible to apply.… more
- State of Georgia (Fulton County, GA)
- Full-Time Instructor - Nurse Aide Georgia - Fulton - Atlanta (https://careers.georgia.gov/jobs/66235/other-jobs-matching/location-only) Hot ... is seeking highly qualified applicants for its Full-Time Instructor ( Nurse Aide) position in the Health & Public Safety...daily instruction of students in-person, on campus and in clinical settings. This is a full-time position, and it… more
- Elevance Health (Atlanta, GA)
- …unless an accommodation is granted as required by law._** The **Medical Management Nurse ** is responsible for review of the most complex or challenging ... **Medical Management Nurse ** **Work schedule: M-F** **8:00am to 5:00pm EST....management experience and requires a minimum of 2 years clinical , utilization review , or managed care experience;… more
- Sharecare (Atlanta, GA)
- … helps to drive cost effective and appropriate resource utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during their ... more, visit www.sharecare.com . **Job Summary:** The Disease Management Nurse has the responsibility for supporting the goals and...and to take the pre and post tests to review competency during orientation. Yearly competency tests are required… more
- Humana (Atlanta, GA)
- …helping people achieve their best health. Humana CarePlus is seeking a Pre-Authorization Nurse who reviews prior authorization requests for appropriate care and ... using clinical judgment. + Refers to internal stakeholders for review depending on case findings. Educates providers on utilization and medical management… more
- Prime Healthcare (Riverdale, GA)
- …experience post-graduation of an accredited school of nursing and a current state Registered Nurse license. + Grandfathered prior to April 1, 2015. Minimum 5 ... designed to facilitate and insure the achievement of quality, clinical and cost effective outcomes and to perform a...accredited school of nursing and a current state Registered Nurse license. + Grandfathered prior to April… more
- Select Medical (Atlanta, GA)
- …highly effective level of care. **Qualifications** **What we're looking for in a Clinical Liaison** **Required Skills:** + Registered Nurse (RN) or Respiratory ... License. + Will consider other designations like LPN, PT, OT etc., upon further review . + Ability to complete clinical assessments of medically complex patients.… more
- Molina Healthcare (Atlanta, GA)
- …an integrated Care Access and Monitoring team responsible for prior authorizations, inpatient/outpatient medical necessity/utilization review , and/or other ... For this position we are seeking a (RN) Registered Nurse who be licensed in the state they reside....+ Functions as a hands-on supervisor, coordinating and monitoring clinical and non- clinical team activities to facilitate… more
- Fresenius Medical Center (Austell, GA)
- …dialysis therapy for patients under the direct supervision of a licensed nurse in accordance with organization policies, procedures, and training and in compliance ... + Monitor patients' response to dialysis therapy. + Obtain vital signs prior to reinfusion; perform all relevant functions necessary for the discontinuation of… more
- State of Georgia (Fulton County, GA)
- …Nursing; and possess and demonstrate two (2) years of work related experience as a Registered Nurse with o ne (1) year of clinical experience as a Registered or ... Conducts off-site visi ts to classroom / lab and clinical si tes to ensu re proper instruction. ;...the students, as needed; + Assist with development and review of program, syllabi, goals and objectives according to… more
- CenterWell (Duluth, GA)
- …assignments. + Must have at least 1 year of home health experience. + Prior packet review / QI experience preferred. + Coding certification is preferred. ... from the field staff and assisting with weekly case conferences. Refers clinical questions to Branch Director as necessary. + Maintains the client hospitalization… more
- Elevance Health (Atlanta, GA)
- …Provider Finder and follows up with provider on referrals given. + Refers cases requiring clinical review to a nurse reviewer; and handles referrals for ... benefit eligibility; provides authorization for inpatient admission, outpatient precertification, prior authorization, and post service requests. + Obtains intake… more
- Inpatient Psych Solutions (Atlanta, GA)
- …supervising psychiatrist will not be involved in day-to-day patient care, but will review charts, provide clinical guidance, and ensure compliance with state ... are expanding, and we're seeking a supervising psychiatrist to support our psychiatric nurse practitioner (PMHNP) working in the Augusta, GA market. About the Role… more