- 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...appropriate courses of action. As a Utilization Management RN working on the OneHome/ Home Solutions… 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 ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… 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 ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...at a time that is best for your schedule. **Work-At- Home / Internet Information:** To ensure Home … 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 ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- Actalent (Atlanta, GA)
- …(RN) with a valid license in GA or Compact. + 1+ years of experience in Utilization Management (UM). + 1+ years of experience in managed care. Additional Skills ... Job Title: Utilization Review - FULLY REMOTE Job Description This...performing eligibility and benefit reviews, identifying patients for case management , conducting quality improvement reviews, and maintaining communication with… more
- Sharecare (Atlanta, GA)
- …appropriate resource utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during their interactions with participants ... learn more, visit www.sharecare.com . **Job Summary:** The Disease Management Nurse has the responsibility for supporting...minimum. + This position will be based in a home office which must satisfy all HIPAA requirements. Sharecare… more
- CVS Health (Atlanta, GA)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... Abuse or Maternity/ Obstetrics experience. **Preferred Qualifications** + 1+ years' Case Management experience or discharge planning, nurse navigator or nurse… more
- Molina Healthcare (Atlanta, GA)
- …chief medical officer on denial decisions. * Resolves escalated complaints regarding utilization management and long-term services and supports (LTSS) issues. * ... **JOB DESCRIPTION** **Job Summary** The Clinical Appeals Nurse (RN) provides support for internal appeals clinical...be required. * Serves as a clinical resource for utilization management , chief medical officer, physicians, and… more
- Molina Healthcare (Atlanta, GA)
- …reports submitted to the Eastern US Quality Improvement Collaborative (EQIC) and/or utilization management committees. + Participates as needed in joint ... must be technologically proficient, self-directed, autonomous and experience working from home . Care Management & Waiver Service Auditing experience is… more
- Evolent (Atlanta, GA)
- …responsible for support and assistance for all cardiology administrative and clinical utilization management and quality improvement functions under the auspices ... is 11:30-8:00 eastern** **OTHER SKILLS and ABILITIES:** Strong clinical, management , communication, and organizational skills. Demonstrated leadership skills Analytic… more
- CenterWell (Marietta, GA)
- …+ Two years as a Registered Nurse with at least one-year of management experience in a home care, hospice or equivalent environment. + Home ... At a minimum, home care experience is required. + Management and people leadership experience, preferred. + OASIS experience, preferred. OASIS certification… more
- CenterWell (Atlanta, GA)
- …minimum of 2 years of experience as a Registered Nurse (RN). + Home health experience is required. + Management and people leadership experience is ... patient information related to the case, including disciplines required, to determine home health or hospice needs. Accountable to ensure patients meet admission… more
- Molina Healthcare (Atlanta, GA)
- … and effective resource management . + Develops and implements a Utilization Management program and action plan, which includes strategies that ensure ... IT and data analysts to produce tools to report, monitor and improve Utilization Management . + Actively participates in regulatory, professional and community… more
- CenterWell (Atlanta, GA)
- …opportunities for education/coaching + Identifying trends and areas of opportunity in pharmacy utilization (pharmacy management ) to impact Part D per Member per ... early detection. The PL is responsible for executing the clinical strategy through the management of their own patient panel as well as those of the clinicians whom… more
- PruittHealth (Atlanta, GA)
- …three years industry experience in a managed care setting focused on experience in utilization review/case management and at least two years case management , ... **JOB PURPOSE:** Responsible for the oversight of clinical care management of community based long-term care population for PruittHealth Premier Dual Eligible… more
- Superior Court of Fulton County (Atlanta, GA)
- …assessment, crisis intervention, individual, family, and group therapy and case management services. + Evaluates and documents client's level of functioning and ... family members, psychologists, educators, and other professionals. + Provides in- home screenings and evaluations of clients. **Qualifications:** **Knowledge, Skills,… more
- AdventHealth (Rome, GA)
- …escalations. The RN Care Manager is under the general supervision of the Care Management Supervisor or Manager or Director of Nursing and is responsible for patient ... patient satisfaction, patient safety, readmission prevention and length of stay management . The RN Care Manager communicates daily with the interdisciplinary team… more