- Molina Healthcare (Atlanta, GA)
- …will work on set schedule) Looking for a RN with experience with appeals, claims review , and medical coding. **Job Summary** Provides support for medical ... and cost-effective member care. **ESSENTIAL JOB DUTIES:** + Facilitates clinical / medical reviews of retrospective medical ...nursing experience, including at least 1 year of utilization review , medical claims review , long-term… more
- Fresenius Medical Center (Lithonia, GA)
- **About this role:** As a Clinical Manager with Fresenius Medical Care, you will ensure that quality patient care is delivered while maintaining clinical ... kidney disease. **Training and advancement:** You will enter our Clinical Leadership Program that creates and supports a culture...a tremendous asset that sets us apart. At Fresenius Medical Care, you will truly make a difference in… more
- Cognizant (Atlanta, GA)
- …necessity determinations to the Health Plan/ Medical Director based on the review of clinical documentation in accordance with Medicare, Medicaid, and ... as well as timely filing deadlines and processes. . Review clinical denials including but not limited...thinking skills to interpret guidelines of internal policies for clinical determination. . Medical Necessity Reviews can… more
- Molina Healthcare (Atlanta, GA)
- **JOB DESCRIPTION** **Job Summary** The Clinical Appeals Nurse (RN) provides support for internal appeals clinical processes - ensuring that appeals requests ... Central time Remote position **Essential Job Duties** * Performs clinical / medical reviews of previously denied cases in...specific programs supported by the plan such as utilization review , medical claims review , long-term… more
- Elevance Health (Atlanta, GA)
- ** Nurse Audit Senior - Payment Integrity Complex and Clinical Audit** **Location:** This role enables associates to work virtually full-time, with the exception ... formerly Payment Integrity, is determined to recover, eliminate and prevent unnecessary medical -expense spending. The ** Nurse Audit Senior** will be responsible… 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 ... Payment Integrity, is determined to recover, eliminate and prevent unnecessary medical -expense spending. The ** Clinical Fraud Investigator II** is responsible… more
- Humana (Atlanta, GA)
- …Manager, Fraud and Waste Investigator: Nurse Audit/ Review performs clinical audit/validation processes to ensure that medical record documentation and ... approach, resources, schedules and goals. The Manager, Fraud and Waste Investigator: Nurse Audit/ Review validates and interprets medical documentation to… more
- Elevance Health (Atlanta, GA)
- …states; therefore, Multi-State Licensure will be required.** The ** Medical Management Nurse ** is responsible for review of the most complex or challenging ... ** Medical Management Nurse ** **Location: Virtual: This...management experience and requires a minimum of 2 years clinical , utilization review , or managed care experience;… more
- Elevance Health (Atlanta, GA)
- …states; therefore, Multi-State Licensure will be required.** The ** Medical Management Nurse ** is responsible for review of the most complex or challenging ... ** Medical Management Nurse ** **Location Virtual: This...management experience and requires a minimum of 2 years clinical , utilization review , or managed care experience;… more
- Emory Healthcare/Emory University (Decatur, GA)
- …be required based on department and specialty PL N: + Must meet all Clinical Nurse Employee Commitments. + Achieves electives/points and contact hours as defined ... 36 hours** Emory Healthcare is seeking a **Unit Charge Nurse , Medical Oncology** responsible for being a...theory, research and experience to respond to changes in clinical situations. This RN professional is able to apply… more
- ChenMed (Decatur, GA)
- …This position may require participation in risk and quality management programs, clinical meetings and other meetings. The Nurse Practitioner, Specialty ... nurse practitioner role. + Facilitate patient/family conferences to review treatment goals, optimize resource utilization, provide family education and identify… more
- Gentiva (Alpharetta, GA)
- …(LCD) criteria per hospice policy and regulatory requirements. + Communicate clinical findings, review treatment plans, lab results, diagnostics, and ... Partnerships. Transform Hospice Care.** We are seeking a dedicated Hospice Nurse Practitioner to perform Face-to-Face (F2F) encounters essential for hospice… more
- Dialysis Clinic, Inc. (Fayetteville, GA)
- …experience; experience preferred **Benefits:** + Paid training with preceptor + Charge nurse continuing education classes + Comprehensive medical , dental and ... and document orders + Participate in patient care conferences, medical rounds and chart review ; document progress...as directed and supervised by the education coordinator, the clinical supervisor and/or the nurse manager +… more
- Humana (Atlanta, GA)
- …community and help us put health first** The Utilization Management Behavioral Health Nurse 2 utilizes clinical nursing skills to support the coordination, ... determination of the appropriate courses of action. The Utilization Management Behavioral Health Nurse 2 completes medical record reviews from medical … more
- CenterWell (Decatur, GA)
- …a part of our caring community and help us put health first** The Nurse Practitioner, Cardiology applies advanced education and clinical competencies within the ... cardiology specialty to achieve optimal patient outcomes. The Nurse , Cardiology Practitioner works on problems of diverse scope...coding specificity. + Follows policy and protocol defined by Clinical Leadership. + Meets with Area Medical … more
- Fresenius Medical Center (Atlanta, GA)
- …to the Inpatient Program Manager, appropriately credentialed physician, patient hospital primary nurse and others as indicated. + Delivers safe, effective care in a ... May be assigned to in-center patient care on an as needed basis + Review and comply with the Code of Business Conduct and all applicable company policies… more
- Sunrise Senior Living (Acworth, GA)
- …NAME** Varenita of West Cobb **Job ID** 2025-235063 **JOB OVERVIEW** The Wellness Nurse is responsible for monitoring the health and well-being of our residents and ... administration, communication with resident support services and families, and maintaining clinical quality assurance while leading and demonstrating the Mission for… more
- PruittHealth (Union City, GA)
- …reviewing medical records and documentation. **KEY RESPONSIBILITIES:** 1. Coordinates clinical competency assessment and training needs of clinical staff, ... ** CLINICAL COMPETENCY COORDINATOR** **Join the PruittHealth family, where...conditions and acuity. 7. Meets regularly with DHS to review learning needs, coordinate training and to implement plans… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …to the excellence of our academic community. **Description** **Acute Care Nurse Practitioner Certificate Required** KEY RESPONSIBILITIES: + Assists in the evaluation ... + Documents the delivery of care in the individual's medical records. + Conducts patient interviews and documents patient...APP Wound Clinic + Perform Full Neuro Exam + Review Imaging (MRI/CT/XR) + Book Elective Cases + Consent… more
- CenterWell (Atlanta, GA)
- …on teamwork and providing a positive and welcoming environment for all. The Nurse Practitioner (NP) or Physician Assistant (PA) works in our team-based care ... of doctors, advanced practice professionals, Pharm D, Care Coach Nurse , MA, Behavioral health specialist, Quality based Coder, Referral...accordance with standards of care. . Follows level of medical care and quality for patients and monitors care… more