- Actalent (Atlanta, GA)
- …(Rotating weekends) About the Role We are seeking a detail-oriented and compassionate Utilization Review Registered Nurse ( RN ) to join our team. In ... Job Title: Utilization Review RN Location: Buckhead, GA (on-site position) Schedule: Monday-Friday, 8:30 AM-5:00 PM… more
- Actalent (Vinings, GA)
- …internal teams (claims, benefits, appeals, risk management). Qualifications: + 1+ years of utilization management / utilization review / case management ... Immediate Hiring for "UM RN " in Atlanta ,GA Must be Located closer...be Located closer to Atlanta, GA Job Description: + Review and approve precertification and medical necessity for designated… more
- Waystar (Atlanta, GA)
- …end user adoption of best practice workflows. We are specifically seeking an experienced Utilization Review Nurse who will serve as an integral contributor ... **ABOUT THIS POSITION** The Clinical Product Consultant for Utilization Management is a member of the Customer...Bachelor of Science in Nursing (BSN) or equivalent (with RN licensure) + 8+ years of clinical experience in… more
- Fresenius Medical Center (Atlanta, GA)
- …auditing activities. + Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. + Manages clinic ... financials including efficient utilization of supplies or equipment and regular profits and...of supplies or equipment and regular profits and loss review . + Responsible for all required network reporting and… more
- CVS Health (Atlanta, GA)
- …+ Perform medical necessity reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse with at least 1 year of experience in a hospital ... setting. + A Registered Nurse that holds an active, unrestricted...lower levels of care. + 1+ years' experience in Utilization Review . + CCM and/or other URAC… more
- Humana (Atlanta, GA)
- …an impact** **Use your skills to make an impact** **Required Qualifications** + **Licensed Registered Nurse ( RN )** in the (appropriate state) with no ... caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing...in an acute care setting + Previous experience in utilization management/ utilization review for a… more
- Molina Healthcare (Atlanta, GA)
- … and/or coding experience, or equivalent combination of relevant education and experience. + Registered Nurse ( RN ). License must be active and unrestricted ... 2 years clinical nursing experience, including at least 1 year of utilization review , medical claims review , long-term services and supports (LTSS), claims… 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 ... (Team will work on set schedule) Looking for a RN with experience with appeals, claims review ,...or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must… more
- Molina Healthcare (Atlanta, GA)
- …authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... JOB DESCRIPTION **Job Summary** The RN Care Review Clinician provides support...cost-effective member care. We are seeking candidates with a RN licensure, Utilization Management knowledge and Medicare… more
- Molina Healthcare (Atlanta, GA)
- …authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... unit (ICU) or emergency room. Previous experience in managed care Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG… more
- CenterWell (Decatur, GA)
- …of Science in Nursing (BSN) strongly preferred. **License/Certifications:** + Active and unrestricted Registered Nurse ( RN ) license or Compact State RN ... clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the...A minimum of 2 years of experience as a Registered Nurse ( RN ). + Home… more
- CenterWell (Atlanta, GA)
- …of Science in Nursing (BSN) strongly preferred. **License/Certifications:** + Active and unrestricted Registered Nurse ( RN ) license or Compact State RN ... clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the...A minimum of 2 years of experience as a Registered Nurse ( RN ). + Home… more
- Humana (Atlanta, GA)
- …**Use your skills to make an impact** **Required Qualifications** + Licensed as a Registered Nurse in the State of Wisconsin, including compact license. + Two ... put health first** Humana is seeking a Prior Authorization RN to join the Wisconsin Medicaid Market (iCare) team....the lives of others. **Essential Duties and Responsibilities:** + Review PA requests for home health services, durable medical… more
- PruittHealth (Atlanta, GA)
- …years industry experience in a managed care setting focused on experience in utilization review /case management and at least two years case management, home ... with long-term care population **MINIMUM LICENSURE/CERTIFICATION REQUIRED BY LAW:** * Licensed Registered Nurse with current, unrestricted license in state of… more
- Evolent (Atlanta, GA)
- …the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. Tasks ... physician-developed medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care… more
- Highmark Health (Atlanta, GA)
- …**Job Description :** **JOB SUMMARY** This job implements effective complimentary utilization and case management strategies for an assigned member panel. Provides ... to appropriate resources for additional support. + Implement care management review processes that are consistent with established industry, corporate, state, and… more
- Elevance Health (Atlanta, GA)
- …fraud and over- utilization by performing medical reviews via prepayment claims review and post payment auditing + Correlates review findings with appropriate ... ** Nurse Auditor Senior - Payment Integrity Complex and...responsible for identifying, monitoring, and analyzing aberrant patterns of utilization and/or fraudulent activities by health care providers through… more
- Evolent (Atlanta, GA)
- …focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and procedures ... work with a group of nurses, providing appeal intake review for one dedicated client. They interact with coordinators...Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to company… more
- Elevance Health (Atlanta, GA)
- ** Nurse Case Manager II** **Location** : This role enables associates to work virtually full-time, with the exception of required in-person training sessions, ... complete the assessment within 48 hours of receipt and meet the criteria._** The ** Nurse Case Manager II** is responsible for care management within the scope of… more
- Elevance Health (Atlanta, GA)
- **Telephonic Nurse Case Manager II** **Sign on Bonus: $2000.** **Location: Virtual: This role enables associates to work virtually full-time, with the exception of ... in different states; therefore, Multi-State Licensure will be required.** The **Telephonic Nurse Case Manager II** is responsible for care management within the… more