- Molina Healthcare (Atlanta, GA)
- JOB DESCRIPTION **Job Summary** The RN Care Review Clinician provides support for clinical member services review assessment processes. Responsible for ... care unit, or in a telemetry type setting. UM medical review experience highly preferred. Work...or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must… 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 ... **JOB DESCRIPTION** **Job Summary** The Clinical Appeals Nurse ( RN ) provides support for internal...to overarching strategy to provide quality and cost-effective member care . Candidates with UM and Appeals experience… 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 ... * Collaborates with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management ( UM...unit (ICU) or emergency room. Previous experience in managed care Prior Auth, Utilization Review / Utilization… 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 ... to other clinical programs. + Collaborates with multidisciplinary teams to promote Molina Care Model + Adheres to UM policies and procedures. + Occasional… 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 ... other clinical programs. * Collaborates with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management ( UM ) policies and… more
- Actalent (Atlanta, GA)
- …Customer Service, Claims, Contracts and Benefits - Appeals, and Risk Management. Essential Skills + Registered Nurse ( RN ) with a valid license in GA or ... Job Title: Utilization Review - FULLY REMOTE Job Description This role...UM ). + 1+ years of experience in managed care . Additional Skills & Qualifications + Experience with MCG… 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 ... by management Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well...bring to the table:** + Two (2) years managed care experience in UM /CM/CDI Department preferred +… more
- Highmark Health (Atlanta, GA)
- …and/or triaging members to appropriate resources for additional support. + Implement care management review processes that are consistent with established ... in a clinical setting **Preferred** + 5 years in UM /CM/QA/Managed Care + 1 year in advanced...in addressing targeted populations **LICENSES or CERTIFICATIONS** **Required** + RN license in PA or WV or DE or… more
- Evolent (Atlanta, GA)
- …people with most complex and costly health conditions. Working across specialties and primary care , we seek to connect the pieces of fragmented health care ... system and ensure people get the same level of care and compassion we would want for our loved...Stay for the culture. **What You'll Be Doing:** The Nurse Practitioner/Physician Assistant (ARNP/NP/PA) Cardiology is responsible for support… more