- Molina Healthcare (Atlanta, GA)
- JOB DESCRIPTION **Job Summary** The RN Care Review Clinician provides support for clinical member services review assessment processes. Responsible for ... * Collaborates with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management ( UM...or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must… more
- Molina Healthcare (Atlanta, GA)
- For this position we are seeking a ( RN ) Registered Nurse who must hold a compact license. This is a Remote position, home office with internet connectivity ... * Collaborates with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management ( UM...or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must… more
- Molina Healthcare (Atlanta, GA)
- …managed care , or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted in ... * Collaborates with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management ( UM...unit (ICU) or emergency room. Previous experience in managed care Prior Auth, Utilization Review / Utilization… more
- Actalent (Atlanta, GA)
- Urgent Hiring for " UM RN " in Atlanta ,GA Must be Located closer to Atlanta, GA Job Description: + Review and approve precertification and medical necessity ... (claims, benefits, appeals, risk management). Required Qualifications + Active RN license in Georgia or Compact State. + BSN...review experience. + Minimum 1 year of managed care experience. + BLS and CPR certifications. + Experience… more
- Actalent (Atlanta, GA)
- Immediate Hiring for " UM RN " in Atlanta ,GA Must be...review / case management experience is must + RN License in GA or Compact License is Mandatory + ... GA Daily Onsite work and rotating weekend shifts Job Description: + Review and approve precertification and medical necessity for designated referrals, procedures,… more
- Evolent (Atlanta, GA)
- …medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care across the continuum ... for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification...of experience with medical management activities in a managed care environment + UM /UR experience + Clinical… more
- Elevance Health (Atlanta, GA)
- Behavioral Health Care Manager I- Behavioral Health Care Manager I **Locations:** The selected candidate must reside within a reasonable commuting distance of ... is granted as required by law. The **Behavioral Health Care Manager I** is responsible for managing psychiatric and...outpatient professional treatment health benefits through telephonic or written review . **How you will make an impact:** + Uses… more
- Elevance Health (Atlanta, GA)
- **Behavioral Health Care Manager I (3rd Shift - After Hours)** **Virtual:** This role enables associates to work virtually full-time, except for required in-person ... for autism and depression, and insightful analytics to improve the delivery of care . **Location:** North Carolina **Work Shift:** 3rd Shift - Holiday and weekend… more
- Elevance Health (Atlanta, GA)
- …unless an accommodation is granted as required by law._ The Behavioral Health Care Manager I is responsible for managing psychiatric and substance abuse or substance ... facility-based and outpatient professional treatment health benefits through telephonic or written review . Primary duties may include but are not limited to: + Uses… more
- Highmark Health (Atlanta, GA)
- …and/or triaging members to appropriate resources for additional support. + Implement care management review processes that are consistent with established ... in a clinical setting **Preferred** + 5 years in UM /CM/QA/Managed Care + 1 year in advanced...**LICENSES or CERTIFICATIONS** **Required** + Current State of PA RN licensure OR Current multi-state licensure through the enhanced… more
- Waystar (Atlanta, GA)
- …user adoption of best practice workflows. We are specifically seeking an experienced Utilization Review Nurse who will serve as an integral contributor in the ... effectiveness of AwareUM technology in creating efficient workflow for UM nurses + Deliver on go-forward product milestones balancing...Bachelor of Science in Nursing (BSN) or equivalent (with RN licensure) + 8+ years of clinical experience in… more