• Inpatient Utilization Review

    Emory Healthcare/Emory University (Atlanta, GA)
    …mentorship, _development,_ and leadership programs + And more **Description** We're seeking an ** Inpatient Registry Utilization Review Nurse (PRN)** who is ... physician and/or physician advisor. This individual will: + Perform utilization review by completing a timely and... review by completing a timely and comprehensive review of all new observation and inpatient more
    Emory Healthcare/Emory University (10/20/25)
    - Save Job - Related Jobs - Block Source
  • Clinical Registered Nurse…

    Cognizant (Atlanta, GA)
    …Monday to Friday - Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced level work related to ... as well as timely filing deadlines and processes. . Review clinical denials including but not limited to referral,...to have to be considered** . Educational background - Registered Nurse (RN) . 2-3 years combined clinical and/or… more
    Cognizant (10/07/25)
    - Save Job - Related Jobs - Block Source
  • Utilization Review Clinician…

    Centene Corporation (Atlanta, GA)
    …and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and ... appropriateness in accordance with regulatory guidelines and criteria + Performs concurrent review of behavioral health (BH) inpatient to determine overall… more
    Centene Corporation (10/10/25)
    - Save Job - Related Jobs - Block Source
  • Care Review Clinician, Inpatient

    Molina Healthcare (Atlanta, GA)
    …* At least 2 years experience, including experience in hospital acute care, inpatient review , prior authorization, managed care, or equivalent combination of ... JOB DESCRIPTION Job SummaryProvides support for clinical member services review assessment processes. Responsible for verifying that services are...relevant education and experience. * Registered Nurse (RN). License must be active and unrestricted… more
    Molina Healthcare (09/25/25)
    - Save Job - Related Jobs - Block Source
  • Bed Planning Coordinator Registered Nurse

    Emory Healthcare/Emory University (Atlanta, GA)
    …programs + And more **Description** We're seeking an **Bed Planning Coordinator Registered Nurse** provides 24/7 coverage for the Capacity Command Center. + ... for all EHC operating units, coordinating room assignments to optimize bed utilization across the health system, critically thinking to manage appropriate patient… more
    Emory Healthcare/Emory University (09/13/25)
    - Save Job - Related Jobs - Block Source
  • RN Medical Claim Review Nurse Remote

    Molina Healthcare (Atlanta, GA)
    …experience, preferably in a hospital setting, including at least 1 year of utilization review , medical claims review , claims auditing, medical necessity ... claim review including diagnosis-related group (DRG) validation, itemized bill review , appropriate level of care, inpatient readmission, and any opportunity… more
    Molina Healthcare (10/19/25)
    - Save Job - Related Jobs - Block Source
  • Medical Claim Review Nurse (RN)

    Molina Healthcare (Atlanta, GA)
    …SKILLS & ABILITIES:** + Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years ... Assists with Complex Claim review including DRG Validation, Itemized Bill Review , Appropriate Level of Care, Inpatient Readmission, and any opportunity… more
    Molina Healthcare (09/06/25)
    - Save Job - Related Jobs - Block Source