- Humana (Atlanta, GA)
- …part of our caring community and help us put health first** The SNF Utilization Management Nurse uses clinical knowledge, communication skills, and ... receives guidance where needed. Follows established guidelines and procedures. The SNF Utilization Management Nurse uses clinical knowledge, communication… more
- CVS Health (Atlanta, GA)
- …Must have active current and unrestricted RN licensure in state of residence. + Utilization Management is a 24/7 operation and work schedules will include ... med surg or specialty area. + Managed Care experience preferred, especially Utilization Management . + Preference for those residing in EST and CST zones.… more
- Prime Healthcare (Riverdale, GA)
- …https://www.eeoc.gov/sites/default/files/2022-10/EEOC\_KnowYourRights\_screen\_reader\_10\_20.pdf Responsibilities The Director of Utilization Management will ... the utilization review and clinical appeals process. The Director of Utilization Management will oversee the respective processes and functions performed by… more
- Humana (Atlanta, GA)
- …a part of our caring community and help us put health first** The Utilization Management (UM) Director, Clinical Strategy and Practice for Medicaid builds ... of how organization capabilities interrelate across the function or segment. The Utilization Management (UM) Director, Clinical Strategy and Practice for… more
- Zurich NA (Atlanta, GA)
- …+ Experience in development and implementation of cost containment programs + Case management , utilization review, catastrophic or disability experience + 5 or ... AVP, Utilization Review & Pharmacy 123092 Zurich Insurance is...recruiting and retaining team members. + Drive the performance management process by communicating job expectations, monitoring and evaluating… more
- CVS Health (Atlanta, GA)
- …Registered Nurse (RN) states. This role is a blended role doing both Case Management and Utilization Management . The RN Case Manager is responsible for ... years' experience in critical care + 6+ months case management or utilization management experience...+ Must be able to obtain multi state Registered Nurse (RN) licensures **Preferred Qualifications** + Case Management… 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 ... the culture. **What You'll Be Doing:** The Evolent Appeals Nurse team offers candidates the opportunity to make a...and regulations. * Practices and maintains the principles of utilization management and appeals management … more
- Molina Healthcare (Atlanta, 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
- Elevance Health (Atlanta, GA)
- **Medical Management Nurse ** **Location:** This role enables associates to work virtually full-time, with the exception of required in-person training sessions, ... will drive the future of health care. The **Medical Management Nurse ** is responsible for reviewing the...experience and requires a minimum of 2 years clinical, utilization review, or managed care experience; or any combination… more
- Sharecare (Atlanta, GA)
- …total healthcare management and ensure cost effective, appropriate resource utilization and quality outcomes. The Clinical Registered Nurse is also ... the participants and their Primary Care Provider according to the disease management program intervention guidelines. A Clinical Registered Nurse is supervised… more
- PruittHealth (Atlanta, GA)
- **JOB PURPOSE:** Senior Nurse Consultant serves as a member of the clinical and region team, to assist centers in achieving clinical excellence. She/he is ... operations and quality improvement practices for designated centers. The senior nurse consultant provides education, mentoring and validation of required systems and… more
- Emory Healthcare/Emory University (Lithonia, GA)
- …ready to join a team that's redefining quality nursing care. The (RUN) Resource Utilization Nurse is primarily responsible for supporting the critical care units ... + Ongoing mentorship, _development,_ and leadership programs **Description** **Rapid Response Registered Nurse / RN** 7p-7:30a / Full Time / 36 Hours per week… more
- Elevance Health (Atlanta, GA)
- …care The **Telephonic Nurse Case Manager II** is responsible for care management within the scope of licensure for members with complex and chronic care needs ... **Telephonic Nurse Case Manager II** **Location:** This role enables...claims or service issues. + Assists with development of utilization /care management policies and procedures. **Minimum Requirements**… more
- ChenMed (Decatur, GA)
- …expanding and we need great people to join our team. The Registered Nurse , Care Line, is responsible for providing telephonic triage directional patient care advice ... client counseling, patient advocacy, health education and referral and resource management to ChenMed patients and their families. Providing on-call coverage, the… more
- ChenMed (Decatur, GA)
- …expanding and we need great people to join our team. The Registered Nurse , Telehealth is responsible for providing telephonic triage directional patient care advice ... issues, client counseling, patient advocacy, health education and referral and resource management to ChenMed patients and their families. The incumbent in this role… more
- Peachtree Orthopedics (Atlanta, GA)
- …and utilization , securing additional staffing when needed. + Resource Management : Assist in ordering medications, managing inventory, and supplies throughout the ... + Operational Oversight: Step into the shoes of the Nurse Manager in their absence, overseeing day-to-day operations. +...to personnel and patients. + Communication Hub: Keep the Nurse Manager informed, providing guidance and assistance to staff,… more
- Highmark Health (Atlanta, GA)
- …Nursing **EXPERIENCE** **Required** + 7 years in any combination of clinical, case/ utilization management and/or disease/condition management experience, or ... on where clinical care is being provided. **Preferred** + Certification in utilization management or a related field + Certification in Case Management … more
- Elevance Health (Atlanta, GA)
- …with providers, claims or service issues. + Assists with development of utilization /care management policies and procedures. **Minimum Requirements:** + Requires ... **Telephonic Nurse Case Manager I** **Location: Virtual:** This role... Case Manager I** is responsible for telephonic care management within the scope of licensure for members with… 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 ... **What You Will Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to company policies and… more
- State of Georgia (Fulton County, GA)
- …experience in the analysis of medical services documentation and related claims 2) Utilization Review 3) Case Management 4) Analysis of CPT codes and/or ... Nurse Investigator Georgia - Fulton - Atlanta (https://careers.georgia.gov/jobs/64040/other-jobs-matching/location-only)...Office of the Attorney General Georgia Department of Law Nurse Investigator- Medicaid Fraud Division *To move forward in… more