- Evolent (Atlanta, GA)
- …scheduled. + Determines medical necessity and appropriateness of services using clinical review criteria. + Accurately documents all review ... for the mission. Stay for the culture. **What You'll Be Doing:** The Nurse Reviewer is responsible for performing precertification and prior approvals. Tasks… more
- Elevance Health (Atlanta, GA)
- ** Nurse Reviewer I** A proud member...reviews that are routine having limited or no previous medical review experience requiring guidance by more ... Hours:** **Monday through Friday, 9:30AM - 6PM (CST).** The ** Nurse Reviewer I** is responsible for conducting...+ Through work experience and mentoring learns to conduct medical necessity clinical screenings of preauthorization request… more
- Molina Healthcare (Atlanta, GA)
- JOB DESCRIPTION **Job Summary** The Medical Claim Review Nurse provides support for medical claim review activities. Responsible for ensuring timely ... Friday 8:00am - 5:00pm. **Essential Job Duties** * Performs clinical / medical reviews of retrospective medical ...hospital setting, including at least 1 year of utilization review , medical claims review , claims… more
- Molina Healthcare (Atlanta, GA)
- …for a RN with experience with appeals, claims review , and medical coding. **Job Summary** Utilizing clinical knowledge and experience, responsible for ... Payment Integrity analytical team; requires decision making pertinent to clinical experience + Documents clinical review...clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review .… more
- Cognizant (Atlanta, GA)
- …necessity determinations to the Health Plan/ Medical Director based on the review of clinical documentation in accordance with Medicare, Medicaid, and ... as well as timely filing deadlines and processes. . Review clinical denials including but not limited...thinking skills to interpret guidelines of internal policies for clinical determination. . Medical Necessity Reviews can… more
- Elevance Health (Atlanta, GA)
- ** Nurse Audit Senior - Payment Integrity Complex and Clinical Audit** **Location:** This role enables associates to work virtually full-time, with the exception ... formerly Payment Integrity, is determined to recover, eliminate and prevent unnecessary medical -expense spending. The ** Nurse Audit Senior** will be responsible… more
- Elevance Health (Atlanta, GA)
- …have License to practice in the state of Georgia** The ** Medical Management Nurse ** is responsible for review of the most complex or challenging cases that ... assessments based on clinical presentation, and apply clinical guidelines and/or policies to evaluate medical ...management experience and requires a minimum of 2 years clinical , utilization review , or managed care experience;… more
- Ageless Mens Health (Marietta, GA)
- …Patient Care, Clinical Operations, Clinic Management, Healthcare Leadership, Nurse Manager, Medical Team Lead, EMR Documentation, Preventive Health, ... care. This is a unique opportunity for a Registered Nurse who thrives on both clinical excellence...compliance, and financial performance. + Conduct new patient consultations, review medical histories, and perform assessments under… more
- Emory Healthcare/Emory University (Decatur, GA)
- …be required based on department and specialty PL N: + Must meet all Clinical Nurse Employee Commitments. + Achieves electives/points and contact hours as defined ... 36 hours** Emory Healthcare is seeking a **Unit Charge Nurse , Medical Oncology** responsible for being a...theory, research and experience to respond to changes in clinical situations. This RN professional is able to apply… more
- ChenMed (Decatur, GA)
- …This position may require participation in risk and quality management programs, clinical meetings and other meetings. The Nurse Practitioner, Specialty ... nurse practitioner role. + Facilitate patient/family conferences to review treatment goals, optimize resource utilization, provide family education and identify… more
- Gentiva (Alpharetta, GA)
- …(LCD) criteria per hospice policy and regulatory requirements. + Communicate clinical findings, review treatment plans, lab results, diagnostics, and ... Partnerships. Transform Hospice Care.** We are seeking a dedicated Hospice Nurse Practitioner to perform Face-to-Face (F2F) encounters essential for hospice… more
- Fresenius Medical Center (Cumming, GA)
- …patients with various shifts and work hours **PURPOSE AND SCOPE:** The registered professional nurse (CAP RN 1) position is an entry level designation into the ... Clinical Advancement Program for Registered Nurses. The CAP RN...months from date of hire. + Performs ongoing, systematic review and analysis of dialysis data for Home Therapy… more
- Elevance Health (Atlanta, GA)
- …preferred. + 3 years of clinical experience as a Registered Nurse is strongly preferred. + Experience reviewing medical records, investigation, and/or ... medical necessity. + Extrapolates and summarizes medical information for medical director, consultants and other external review . + Research to determine… more
- Dialysis Clinic, Inc. (Atlanta, GA)
- …experience; experience preferred **Benefits:** + Paid training with preceptor + Charge nurse continuing education classes + Comprehensive medical , dental and ... and document orders + Participate in patient care conferences, medical rounds and chart review ; document progress...as directed and supervised by the education coordinator, the clinical supervisor and/or the nurse manager +… more
- Veterans Affairs, Veterans Health Administration (Atlanta, GA)
- …determined by the VHA Education Loan Repayment Services program office after review of the EDRP application. Former EDRP participants ineligible to apply. ... is equipped with comprehensive knowledge of the home health referral process, clinical documentation requirements, and the coordination of home health care services… more
- CenterWell (Decatur, GA)
- …a part of our caring community and help us put health first** The Nurse Practitioner, Cardiology applies advanced education and clinical competencies within the ... cardiology specialty to achieve optimal patient outcomes. The Nurse , Cardiology Practitioner works on problems of diverse scope...coding specificity. + Follows policy and protocol defined by Clinical Leadership. + Meets with Area Medical … more
- PruittHealth (Marietta, GA)
- …reviewing medical records and documentation. **KEY RESPONSIBILITIES:** 1. Coordinates clinical competency assessment and training needs of clinical staff, ... ** CLINICAL COMPETENCY COORDINATOR** **Join the PruittHealth family, where...conditions and acuity. 7. Meets regularly with DHS to review learning needs, coordinate training and to implement plans… more
- Ageless Mens Health (Marietta, GA)
- …training, compliance, and financial performance. + Conduct new patient consultations, review medical histories, and perform physical assessments. + Order, ... a unique opportunity for a licensed provider who thrives on both clinical excellence and team leadership, driving growth by delivering exceptional patient… more
- CVS Health (Atlanta, GA)
- …benefit overall claim management. + Using a holistic approach, consults with clinical colleagues, supervisors, Medical Directors and/or other programs to ... in the US with virtual training.** American Health Holding, Inc (AHH) is a medical management company that is a division within Aetna/CVS Health. Founded in 1993,… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …to the excellence of our academic community. **Description** **Acute Care Nurse Practitioner Certificate Required** KEY RESPONSIBILITIES: + Assists in the evaluation ... + Documents the delivery of care in the individual's medical records. + Conducts patient interviews and documents patient...APP Wound Clinic + Perform Full Neuro Exam + Review Imaging (MRI/CT/XR) + Book Elective Cases + Consent… more