- 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
- 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
- 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
- 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
- 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
- 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 (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