- Emory Healthcare/Emory University (Atlanta, GA)
- …+ Ongoing mentorship and leadership programs + And more! **Description** The **Registry Utilization Review Nurse ** (PRN) is responsible for conducting ... attending physician and/or physician advisor. + The UR RN (PRN) will perform utilization review by completing a timely and comprehensive review of all new… more
- Humana (Atlanta, GA)
- …skills to make an impact** **Required Qualifications** + Compact licensure + Licensed Registered Nurse (RN) in the (appropriate state) with no disciplinary ... of our caring community and help us put health first** The SNF Utilization Management Nurse uses clinical knowledge, communication skills, and independent… more
- Zurich NA (Atlanta, GA)
- AVP, Utilization Review & Pharmacy 123092 Zurich Insurance is seeking an AVP, Utilization Review & Pharmacy. This is a fully remote position, offering ... flexibility of a home-based office. As the AVP of Utilization Review & Pharmacy, you will lead...more years of experience in the Nursing areaAND + Registered Professional Nurse license in residential area… more
- CVS Health (Atlanta, GA)
- …all with heart, each and every day. **Position Summary** This Case Manager - Registered Nurse (RN) position is with Aetna's National Medical Excellence (NME) ... to apply, however, preference is for candidates in compact Registered Nurse (RN) states. This role is...is a blended role doing both Case Management and Utilization Management. The RN Case Manager is responsible for… more
- Sharecare (Atlanta, GA)
- …cost effective, appropriate resource utilization and quality outcomes. The Clinical Registered Nurse is also responsible for early identification of those ... for everyone. To learn more, visit www.sharecare.com . **Job Summary:** The Clinical Registered Nurse has the responsibility for supporting the goals and… more
- Fresenius Medical Center (Lithonia, GA)
- …all FMS manuals. + Accountable for completion of the Annual Standing Order Review and ICD coding. + Checks correspondence whether electronic, paper or voice mail, ... supporting billing and collection activities. + Responsible for efficient utilization of medication, laboratory, inventory, supplies and equipment to achieve… more
- Fresenius Medical Center (College Park, 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
- Molina Healthcare (Atlanta, GA)
- …Managed Care Experience in the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and Support, ... outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical/medical reviews of previously denied cases… more
- Molina Healthcare (Atlanta, GA)
- **JOB DESCRIPTION** Opportunity for experienced Utilization Review RN in United States who has a compact, multi-state license. This team reviews the prior ... requests for transplants; the ideal candidate will have experience either in utilization review or case management for transplants. Preference will be… more
- CenterWell (Decatur, GA)
- …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and ... delivery, and documentation requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking for performance … more
- PruittHealth (Norcross, GA)
- …C-2 Certification within 9 months from hire date** + Current and unrestricted Registered Nurse (RN) licensure in state of practice. **ADDITIONAL QUALIFICATIONS: ... in ensuring appropriate data elements are included in the POC. + Review visit utilization for appropriateness as per care guidelines, best practices, and patient… more