- Humana (Atlanta, GA)
- …community and help us put health first** Full-Time, Remote Telephonic opportunity The Utilization Management Nurse 2 utilizes clinical nursing skills to ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...appropriate courses of action. As a Utilization Management RN working on the OneHome/ Home Solutions… more
- Humana (Atlanta, GA)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- CVS Health (Atlanta, GA)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... Abuse or Maternity/ Obstetrics experience. **Preferred Qualifications** + 1+ years' Case Management experience or discharge planning, nurse navigator or nurse… more
- CenterWell (Atlanta, GA)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and ... **Required Qualifications** + Must be a licensed Registered Compact Nurse license (RN) with no disciplinary action and ability...volume and fast paced environment + Previous experience in utilization management + Education: BSN or bachelor's… more
- ChenMed (Decatur, GA)
- … management programs, clinical meetings and other meetings. The Nurse Practitioner, Specialty incumbent adheres to strict departmental goals/objectives, standards ... we need great people to join our team. The Nurse Practitioner (NP), Specialty acts as part of the...care in nursing homes, skilled nursing facilities (SNF) and home settings, or supporting a Cardiologist practice. The responsibilities… more
- Evolent (Atlanta, GA)
- …Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. Tasks are performed ... medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care across the continuum… 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 ... Be Doing:** + Practices and maintains the principles of utilization management and appeals management ...all employees have the following technical capability at their home : High speed internet over 10 Mbps and, specifically… more
- Evolent (Atlanta, GA)
- …responsible for support and assistance for all cardiology administrative and clinical utilization management and quality improvement functions under the auspices ... NCH has business OTHER SKILLS and ABILITIES: Strong clinical, management , communication, and organizational skills. Demonstrated leadership skills Analytic skills… more
- Fresenius Medical Center (Carrollton, GA)
- …and acting on adverse events and action thresholds. + Oversees facility's Home Therapies Program if applicable. + Accountable for compliance with all applicable ... and acts as the liaison for patient care as per the disease management agreement, including initial and ongoing validation of member eligibility. Facilitate timely… more
- Fresenius Medical Center (Atlanta, GA)
- …Quality, and Technical Services departments. + Collaborates with or functions as the Home Therapies Program Manager to oversee the facility's Home Therapies ... Classification of Disease (ICD) coding. + Manages clinic financials including efficient utilization of supplies or equipment and regular profits and loss review. +… more
- CenterWell (Marietta, GA)
- …+ Two years as a Registered Nurse with at least one-year of management experience in a home care, hospice or equivalent environment. + Home ... At a minimum, home care experience is required. + Management and people leadership experience, preferred. + OASIS experience, preferred. OASIS certification… more
- CenterWell (Atlanta, GA)
- …minimum of 2 years of experience as a Registered Nurse (RN). + Home health experience is required. + Management and people leadership experience is ... evening through Monday morning to support clinical operations across multiple home health branch locations.** The **RN Weekend Clinical Manager** provides weekend… more
- Molina Healthcare (Atlanta, GA)
- …of health care services provided to plan members. * Supports plan utilization management program and accompanying action plan(s), which includes strategies ... the most appropriate care at the most effective setting. *Evaluates effectiveness of utilization management (UM) practices - actively monitoring for over and… more
- CenterWell (Morrow, GA)
- …opportunities for education/coaching + Identifying trends and areas of opportunity in pharmacy utilization (pharmacy management ) to impact Part D per Member per ... early detection. The PL is responsible for executing the clinical strategy through the management of their own patient panel as well as those of the clinicians whom… more
- Humana (Atlanta, GA)
- …others. **Essential Duties and Responsibilities:** + Review PA requests for home health services, durable medical equipment, outpatient therapies, skilled nursing ... inpatient and subacute activity daily for outcomes related to readmission, utilization , quality of care and provider performance in compliance with Humana/iCare… more
- Superior Court of Fulton County (Atlanta, GA)
- …assessment, crisis intervention, individual, family, and group therapy and case management services. + Evaluates and documents client's level of functioning and ... family members, psychologists, educators, and other professionals. + Provides in- home screenings and evaluations of clients. **Qualifications:** **Knowledge, Skills,… more
- Molina Healthcare (Atlanta, GA)
- …with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications * At ... For this position we are seeking a (RN) Registered Nurse who must hold a compact license. This is...hold a compact license. This is a Remote position, home office with internet connectivity of high speed required… more
- CVS Health (Atlanta, GA)
- …As a CPC, you will collaborate closely with account teams, care management , Regional Analytic Consulting, and key enterprise partners to support customer objectives. ... to: + Deliver forward-thinking clinical insights derived from analyzing clinical utilization patterns and member behavior impact on medical costs. + Recommend… more
- Molina Healthcare (Atlanta, GA)
- …with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications * At ... (either one or both)) This is a Remote position, home office with internet connectivity of high speed required....equivalent combination of relevant education and experience. * Registered Nurse (RN). License must be active and unrestricted in… more