- 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)
- …will work on set schedule) Looking for a RN with experience with appeals, claims review , and medical coding. **Job Summary** Provides support for medical ... and cost-effective member care. **ESSENTIAL JOB DUTIES:** + Facilitates clinical / medical reviews of retrospective medical ...nursing experience, including at least 1 year of utilization review , medical claims review , long-term… 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)
- ** Clinical Fraud Investigator II - Registered Nurse and CPC - Calrelon Payment Integrity SIU** **Location:** This role requires associates to be in-office 1 - 2 ... Payment Integrity, is determined to recover, eliminate and prevent unnecessary medical -expense spending. The ** Clinical Fraud Investigator II** is responsible… more
- Humana (Atlanta, GA)
- …Manager, Fraud and Waste Investigator: Nurse Audit/ Review performs clinical audit/validation processes to ensure that medical record documentation and ... approach, resources, schedules and goals. The Manager, Fraud and Waste Investigator: Nurse Audit/ Review validates and interprets medical documentation to… 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
- 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
- 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
- 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
- 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 (Fort Mcpherson, GA)
- …determined by the VHA Education Loan Repayment Services program office after review of the EDRP application. Former EDRP participants ineligible to apply. ... Responsibilities Functions or Scope of Assigned Duties of Assistant Nurse Manager: The Nurse III Assistant Nurse Manager (ANM) supports the Nurse Manager… 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
- Fresenius Medical Center (Atlanta, GA)
- …to the Inpatient Program Manager, appropriately credentialed physician, patient hospital primary nurse and others as indicated. + Delivers safe, effective care in a ... May be assigned to in-center patient care on an as needed basis + Review and comply with the Code of Business Conduct and all applicable company policies… more
- Humana (Atlanta, GA)
- …needs and by providing guidance along the healthcare continuum. You will perform clinical case review on members during an inpatient hospital admission. You ... us put health first** The NICU Care Manager, Telephonic Nurse 2, in a telephonic environment, assesses and evaluates...+ Bilingual is a plus - preferably Spanish + Clinical claim review experience **Additional Information** +… 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
- CenterWell (Atlanta, GA)
- …on teamwork and providing a positive and welcoming environment for all. The Nurse Practitioner (NP) or Physician Assistant (PA) works in our team-based care ... of doctors, advanced practice professionals, Pharm D, Care Coach Nurse , MA, Behavioral health specialist, Quality based Coder, Referral...accordance with standards of care. . Follows level of medical care and quality for patients and monitors care… more
- CVS Health (Atlanta, GA)
- …criteria to evaluate outpatient and inpatient services requiring precertification and concurrent review . + Conduct clinical reviews via phone and electronic ... Holding, Inc. (AHH), a division of Aetna/CVS Health, is a URAC-accredited medical management organization founded in 1993. We provide flexible, cost-effective care… more