- Centene Corporation (Atlanta, GA)
- …the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, ... a fresh perspective on workplace flexibility. **Position Purpose:** Analyzes all prior authorization requests to determine medical necessity of service and… more
- Elevance Health (Atlanta, GA)
- ** Clinical Fraud Investigator II - Registered Nurse and CPC - Calrelon Payment Integrity SIU** **Location:** This role requires associates to be in-office 1 - 2 ... to recover, eliminate and prevent unnecessary medical-expense spending. The ** Clinical Fraud Investigator II** is responsible for identifying issues and/or… more
- State of Georgia (Fulton County, GA)
- Full-Time Instructor - Nurse Aide Georgia - Fulton - Atlanta (https://careers.georgia.gov/jobs/66235/other-jobs-matching/location-only) Hot ... is seeking highly qualified applicants for its Full-Time Instructor ( Nurse Aide) position in the Health & Public Safety...daily instruction of students in-person, on campus and in clinical settings. This is a full-time position, and it… more
- CVS Health (Atlanta, GA)
- …user up front. **Required Qualifications** * 1 year UM, concurrent review or prior authorization * 5 years of clinical experience required * 5 years ... telephone queue working with providers to secure additional information for prior authorization review . CVS health requires eligible colleagues identified as… more
- Humana (Atlanta, GA)
- …**Preferred Qualifications** + Bachelor's or Master's degree in Nursing + Prior /current experience in Utilization Management/Utilization Review with MCG + ... community and help us put health first** The **Telephonic Nurse Case Manager** will be a member of the...each beneficiary's capacity for self-care, to cost-effectively achieve desired clinical outcomes and to enhance quality of medical care.… more
- Select Medical (Atlanta, GA)
- …highly effective level of care. **Qualifications** **What we're looking for in a Clinical Liaison** **Required Skills:** + Registered Nurse (RN) or Respiratory ... License. + Will consider other designations like LPN, PT, OT etc., upon further review . + Ability to complete clinical assessments of medically complex patients.… more
- Molina Healthcare (Atlanta, GA)
- …Marketplace business. The candidate must have an RN licensure. Experience with UM medical review and prior authorization is a bonus. PEGA knowledge is highly ... compliance with all state and federal regulations and guidelines. + Analyzes clinical service requests from members or providers against evidence based clinical… more
- CenterWell (Marietta, GA)
- …he / she practices + Have at least 1 year of home health experience. + Prior packet review / QI experience preferred. + Coding certification is preferred. + Must ... from the field staff and assisting with weekly case conferences. Refers clinical questions to Branch Director as necessary. + Maintains the client hospitalization… more
- Fresenius Medical Center (Austell, GA)
- …dialysis therapy for patients under the direct supervision of a licensed nurse in accordance with organization policies, procedures, and training and in compliance ... + Monitor patients' response to dialysis therapy. + Obtain vital signs prior to reinfusion; perform all relevant functions necessary for the discontinuation of… more
- State of Georgia (Fulton County, GA)
- …Nursing; and possess and demonstrate two (2) years of work related experience as a Registered Nurse with o ne (1) year of clinical experience as a Registered or ... Conducts off-site visi ts to classroom / lab and clinical si tes to ensu re proper instruction. ;...the students, as needed; + Assist with development and review of program, syllabi, goals and objectives according to… more
- Public Consulting Group (Atlanta, GA)
- …learn more, visit www.publicconsultinggroup.com . PCG is currently seeking a qualified Registered Nurse to perform as a Case Manager. The Case Manager will be ... providing case management services, assisting families and program recipients through prior approval of certain healthcare services, and collaborating with the… more
- Sedgwick (Atlanta, GA)
- …Workplaces in Financial Services & Insurance RN Consultant Sr - Professional Liability ** Prior Legal Nurse Consulting expereince highly preferred in order to be ... Consultant) Certification or training preferred. **Experience** Five (5) years related clinical nursing experience and two (2) years nurse consultant experience… more
- Elevance Health (Atlanta, GA)
- …precertification, prior authorization, and post service requests. + Refers cases requiring clinical review to a Nurse reviewer. + Responsible for the ... Management Representative I** will be responsible for coordinating cases for precertification and prior authorization review . **How you will make an impact:** +… more
- Inpatient Psych Solutions (Atlanta, GA)
- …supervising psychiatrist will not be involved in day-to-day patient care, but will review charts, provide clinical guidance, and ensure compliance with state ... are expanding, and we're seeking a supervising psychiatrist to support our psychiatric nurse practitioner (PMHNP) working in the Augusta, GA market. About the Role… more
- Baylor Scott & White Health (Atlanta, GA)
- …may vary based on position type and/or level **Job Summary** As a Registered Nurse Case Management , oversee, strategize, and monitor the team to provide quality ... to ensure quality outcomes and effective medical management through regular performance review and auditing of work products. + Represents the organization at… more