- Cognizant (Atlanta, GA)
- …you need to have to be considered** . Educational background - Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management ... Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact...care revenue cycle or clinic operations . Experience in utilization management to include Clinical Appeals and… more
- Humana (Atlanta, GA)
- …community and help us put health first** Full-Time, Remote Telephonic opportunity The Utilization Management Nurse 2 utilizes clinical nursing skills to ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are...+ Minimum of Associate Degree in nursing + Licensed Registered Nurse (RN) in a compact state… more
- Humana (Atlanta, GA)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... independent determination of the appropriate courses of action. The Utilization Management Nurse 2 uses clinical...skills to make an impact** **Required Qualifications** + Licensed Registered Nurse (RN) in the (appropriate state)… more
- Humana (Atlanta, GA)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... 7pm EST approximately 3-4 Thursday and Friday's annually. The Utilization Management Nurse 2 uses clinical...Qualifications** + Minimum of an Associate's degree + Licensed Registered Nurse (RN) with no disciplinary action… more
- CVS Health (Atlanta, GA)
- …good standing Arizona clinical and/or counseling license, specifically RN ( Registered Nurse ), LPC (Licensed Professional Counselor), LAC (Licensed Associate ... skills to coordinate, document, and communicate all aspects of the utilization /benefit management program. + Conduct clinical reviews for adult inpatient… 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 ... is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that...setting. + A Registered Nurse that holds an active, unrestricted… more
- Humana (Atlanta, GA)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... independent determination of the appropriate courses of action. The Utilization Management Nurse 2 uses clinical...skills to make an impact** **Required Qualifications** + **Licensed Registered Nurse (RN)** in the (appropriate state)… more
- Molina Healthcare (Atlanta, GA)
- …health, pharmacy, etc.), or equivalent combination of relevant education and experience. * Registered Nurse (RN). License must be active and unrestricted in ... **JOB DESCRIPTION** **Job Summary** The Clinical Appeals Nurse (RN) provides support...hearings as may be required. * Serves as a clinical resource for utilization management, chief medical… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …leadership programs + And more **Description** We're seeking an **Transfer Center Registered Nurse is** responsible for accepting incoming referral information ... indvidual: + Coordinates, prioritizes, and optimizes patient flow using knowledge of clinical and operational activities throughout the hospital network. + Collects … more
- Sharecare (Atlanta, GA)
- …to drive cost effective and appropriate resource utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during their ... to enable individuals with disabilities to perform the essential functions. + Current Registered Nurse multi-state compact license in the state in which they… more
- CenterWell (Marietta, GA)
- …+ Graduate of an accredited School of Nursing. + Current state license as a Registered Nurse . + Proof of current CPR. + Valid driver's license, auto insurance ... caring community and help us put health first** The Clinical Manager, Home Health Nursing enables patients to stay...and reliable transportation. + Two years as a Registered Nurse with at least one-year of… more
- CenterWell (Atlanta, GA)
- …Science in Nursing (BSN) strongly preferred. **License/Certifications:** + Active and unrestricted Registered Nurse (RN) license or Compact State RN license with ... hours spanning Friday evening through Monday morning to support clinical operations across multiple branch locations.** The **Weekend Regional...A minimum of 2 years of experience as a Registered Nurse (RN). + Home health experience… more
- CenterWell (Atlanta, GA)
- …to the strategic intent Overseeing other clinicians which includes Physicians, Advanced Registered Nurse Practitioners (ARNP), and Physicians Assistants (PA) in: ... early detection. The PL is responsible for executing the clinical strategy through the management of their own patient...+ Identifying trends and areas of opportunity in pharmacy utilization (pharmacy management) to impact Part D per Member… more
- Molina Healthcare (Atlanta, GA)
- …internal meetings. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse (RN). **Required Experience** 1-3 years of hospital ... compliance with all state and federal regulations and guidelines. + Analyzes clinical service requests from members or providers against evidence based clinical… 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 Provides support for clinical member services review assessment processes. Responsible for...to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications *… more
- Datavant (Atlanta, GA)
- …clinical knowledge and expertise successfully. Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well versed in DRG downgrade ... of the Denial Prevention Specialist is to effectively defend utilization of available health services, review of admissions for...by management Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …Unit or PGP practice area, the **Director of Patient Care Services ( Registered Nurse / RN)** will lead and manage clinical operations and initiatives to ... vision. + Develop programs to enhance value-based services and regulatory compliance. ** Clinical & Operational Oversight:** + Oversee clinical and operational… more
- Molina Healthcare (Atlanta, GA)
- …behavioral health, or equivalent combination of relevant education and experience. * Registered Nurse (RN), Licensed Vocational Nurse (LVN), Licensed ... Required Qualifications * At least 5 years of health care experience, including experience in clinical operations, and at least 3 or more years in one or more of the… more
- Fresenius Medical Center (Marietta, GA)
- Position requires Registered Nurse with experience working in hemodialysis and a passion for building and leading great teams. Will have 25+ direct reports, all ... clinical . Will manage programs at 3 locations. 1) 677...facilities. Ensures efficient staff/ patient scheduling and efficient staffing utilization following company policy while maintaining a safe environment.… more
- PruittHealth (Atlanta, GA)
- …with long-term care population **MINIMUM LICENSURE/CERTIFICATION REQUIRED BY LAW:** * Licensed Registered Nurse with current, unrestricted license in state of ... **JOB PURPOSE:** Responsible for the oversight of clinical care management of community based long-term care...in a managed care setting focused on experience in utilization review/case management and at least two years case… more