- Actalent (Atlanta, GA)
- …AM-5:00 PM (Rotating weekends) About the Role We are seeking a detail-oriented and compassionate Utilization Review Registered Nurse (RN) to join our ... Job Title: Utilization Review RN - Critical Care...Job Title: Utilization Review RN - Critical Care Location: Buckhead, GA...+ BSN degree required. + Minimum 1 year of utilization review experience. + Minimum 1 year… more
- CVS Health (Atlanta, GA)
- …+ Perform medical necessity reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse with at least 1 year of experience in a hospital ... setting. + A Registered Nurse that holds an active, unrestricted...lower levels of care. + 1+ years' experience in Utilization Review . + CCM and/or other URAC… more
- Humana (Atlanta, GA)
- …impact** **Use your skills to make an impact** **Required Qualifications** + **Licensed Registered Nurse (RN)** in the (appropriate state) with no disciplinary ... caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing...in an acute care setting + Previous experience in utilization management/ utilization review for a… more
- Fresenius Medical Center (Atlanta, GA)
- …auditing activities. + Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. + Manages clinic ... financials including efficient utilization of supplies or equipment and regular profits and...of supplies or equipment and regular profits and loss review . + Responsible for all required network reporting and… more
- Molina Healthcare (Atlanta, GA)
- …At least 2 years clinical nursing experience, including at least 1 year of utilization review , medical claims review , long-term services and supports (LTSS), ... and/or coding experience, or equivalent combination of relevant education and experience. + Registered Nurse (RN). License must be active and unrestricted in… more
- Evolent (Atlanta, GA)
- …the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. Tasks ... physician-developed medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care… more
- Molina Healthcare (Atlanta, GA)
- …authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse (RN). License must be active and unrestricted in ... unit (ICU) or emergency room. Previous experience in managed care Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG… more
- Molina Healthcare (Atlanta, GA)
- For this position we are seeking a (RN) Registered Nurse who must hold a compact license. This is a Remote position, home office with internet connectivity of ... Looking for a RN with experience with appeals, claims review , and medical coding. JOB DESCRIPTION Job SummaryProvides support...or equivalent combination of relevant education and experience. * Registered Nurse (RN). License must be active… more
- Molina Healthcare (Atlanta, GA)
- …authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse (RN). License must be active and unrestricted in ... JOB DESCRIPTION **Job Summary** The RN Care Review Clinician provides support for clinical member services...care. We are seeking candidates with a RN licensure, Utilization Management knowledge and Medicare Appeals is strongly preferred.… more
- Molina Healthcare (Atlanta, GA)
- …authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse (RN). License must be active and unrestricted in ... state of KY and or compact licensure The Care Review Clinician Inpatient Review BH will provide...to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications *… more
- CenterWell (Marietta, GA)
- …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and ... requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking...School of Nursing. + Current state license as a Registered Nurse . + Proof of current CPR.… more
- CenterWell (Atlanta, GA)
- …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and ... Science in Nursing (BSN) strongly preferred. **License/Certifications:** + Active and unrestricted Registered Nurse (RN) license or Compact State RN license with… more
- Highmark Health (Atlanta, GA)
- …years of experience in Managed Care **LICENSES or CERTIFICATIONS** **Required** + Registered Nurse **Preferred** + Certified Medical Coder or related **SKILLS** ... and the proper action to complete the retrospective claim review with the goal of proper and timely payment...data to assure appropriate level of payment and resource utilization . It is also used to identify issues which… more
- Elevance Health (Atlanta, GA)
- …on relatively complex case types that do not require the training or skill of a registered nurse . Acts as a resource for more junior Clinicians. **How You Will ... + Requires a minimum of 6 years of clinical experience and/or utilization review experience. + Current active, valid and unrestricted LPN/LVN or RN license… more
- CenterWell (Morrow, GA)
- …to the strategic intent Overseeing other clinicians which includes Physicians, Advanced Registered Nurse Practitioners (ARNP), and Physicians Assistants (PA) in: ... inquiries, requests, and complaints from patients + Ongoing chart review / audit of clinical staff to ensure quality...+ Identifying trends and areas of opportunity in pharmacy utilization (pharmacy management) to impact Part D per Member… more
- Humana (Atlanta, GA)
- …**Use your skills to make an impact** **Required Qualifications** + Licensed as a Registered Nurse in the State of Wisconsin, including compact license. + Two ... to improve the lives of others. **Essential Duties and Responsibilities:** + Review PA requests for home health services, durable medical equipment, outpatient… more
- State of Georgia (Fulton County, GA)
- …. Knowledge of DATEP, NTP, ARMHP, and/or CLA services . Experience as a Registered Nurse /LPN, or licensed/certified professional in a related field or setting . ... Experience in utilization review and/or quality assurance in a healthcare setting . Experience in conducting assessments and evaluations based on regulations,… more