- Molina Healthcare (Atlanta, GA)
- JOB DESCRIPTION **Job Summary** The RN Care Review Clinician provides support for clinical member services review assessment processes. Responsible ... least 2 years experience, including experience in hospital acute care , inpatient review , prior authorization, managed ...or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must… more
- Molina Healthcare (Atlanta, GA)
- …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)
- …managed care , or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted in ... JOB DESCRIPTION Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically… more
- Molina Healthcare (Atlanta, GA)
- …for internal meetings. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse ( RN ). **Required Experience** 1-3 years of ... clinic experience. **Required License, Certification, Association** Active, unrestricted State Registered Nursing ( RN ) license in good standing. **Preferred… more
- Highmark Health (Atlanta, GA)
- …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...outcomes. Will monitor and analyze the delivery of health care services in accordance with claims submitted, and analyzes… more
- Datavant (Atlanta, GA)
- …with clinical knowledge and expertise successfully. Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well versed in DRG downgrade ... government agencies, and those who deliver and pay for care . By joining Datavant today, you're stepping onto a...by management Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …complete an ADN-to-BSN program within two years of entering the RN Clinician role. Licensure: + A valid, unencumbered Registered Nursing License approved by ... cancer screening - ( this location sends out the Prep Instructions and review any questions the patients may have). **Key Responsibilities:** Clinical Practice &… more
- Elevance Health (Atlanta, GA)
- …in different states; therefore, Multi-State Licensure will be required.** The **Medical Management Nurse ** is responsible for review of the most complex or ... **Medical Management Nurse ** **Location Virtual: This role enables associates to...and requires a minimum of 2 years clinical, utilization review , or managed care experience; or any… more
- Elevance Health (Atlanta, GA)
- …law. * Must have compact license for the state of Georgia The **Medical Management Nurse ** is responsible for review of the most complex or challenging cases ... Director on particularly peculiar or complex cases as the nurse deems appropriate. + May make recommendations on alternate...and requires a minimum of 2 years clinical, utilization review , or managed care experience; or any… more