- 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
- Emory Healthcare/Emory University (Atlanta, GA)
- …leadership programs + And more **Description** We're seeking an **Inpatient Registry Utilization Review Nurse (PRN)** who is responsible for conducting medical ... Interqual Guidelines in conjunction with a review of the patient chart, clinical nursing judgement, and discussions with the attending physician and/or physician… 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
- Fresenius Medical Center (Lithonia, GA)
- **About this role:** As a Clinical Manager with Fresenius Medical Care, you will ensure that quality patient care is delivered while maintaining clinical ... or chronic kidney disease. **Training and advancement:** You will enter our Clinical Leadership Program that creates and supports a culture of continuous learning… 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
- ChenMed (Decatur, GA)
- …rapidly expanding and we need great people to join our team. The Registered Nurse , Telehealth is responsible for providing telephonic triage directional patient ... patients and their families. The incumbent in this role provides remote clinical emergency triage services and assessments within license and as possible given… 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
- Centene Corporation (Atlanta, GA)
- …required or + Licensed Mental Health Professional (LMHP) required or + RN - Registered Nurse - State Licensure and/or Compact State Licensure required Pay Range: ... the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified,… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …who will function as a liaison between the blood bank and clinical staff, utilizing tools such as audits, quality improvement activities, educational presentations, ... will be responsible for the following job duties: + Clinical Collaboration & Support + 1. Collaborate with all...revision of policies related to blood administration, consent, and utilization guidelines. + Education & Training + 1. Provide… more
- Evolent (Atlanta, GA)
- …+ Performs other duties as assigned. **The Experience You'll Need (Required):** + Registered Nurse or Licensed Practical/Vocational Nurse with a current, ... for the mission. Stay for the culture. **What You'll Be Doing:** The Nurse Reviewer is responsible for performing precertification and prior approvals. Tasks are… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …EHC operating unit. + Manages real-time quality assurance reviews, escalates critical clinical issues related to hospital transfers and patient placement in real ... + Coordinates, prioritizes, and optimizes patient flow using knowledge of clinical and operational activities throughout the hospital network. + 1. Patient… more
- Molina Healthcare (Atlanta, GA)
- …and/or coding experience, or equivalent combination of relevant education and experience. * Registered Nurse (RN). License must be active and unrestricted in ... JOB DESCRIPTION **Job Summary** The Medical Claim Review Nurse provides support for medical claim review activities....or modification of payment decisions. * Serves as a clinical resource for utilization management, chief medical… more
- Veterans Affairs, Veterans Health Administration (Atlanta, GA)
- …equivalent to a bachelor's level degree in Nursing may have opportunity to become registered as a nurse with a state licensing board prior to completion ... is equipped with comprehensive knowledge of the home health referral process, clinical documentation requirements, and the coordination of home health care services… 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
- Molina Healthcare (Atlanta, GA)
- …skills. + Microsoft Office suite/applicable software program(s) proficiency. **Preferred Qualifications** + Registered Nurse (RN). The license must be active and ... **JOB DESCRIPTION** **Job Summary** The Delegation Oversight Nurse provides support for delegation oversight quality improvement activities. Responsible for… more
- Molina Healthcare (Atlanta, GA)
- …and electronic medical record (EMR) experience. Preferred Qualifications * Experience as a registered nurse or nurse practitioner in a home health, ... primary care and medical care services to members - primarily in non- clinical settings where members feel most comfortable, including in-home, community and nursing… more
- Molina Healthcare (Atlanta, GA)
- …for denial or modification of payment decisions. + Serves as a clinical resource for Utilization Management, Chief Medical Officers, Physicians, and ... of Nursing **REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:** + Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or… more
- CenterWell (Decatur, GA)
- …Science in Nursing (BSN) strongly preferred. **License/Certifications:** + Active and unrestricted Registered Nurse (RN) license or Compact State RN license with ... to as our CWHH Decatur, GA branch.** The **RN Clinical Manager** coordinates and oversees all direct care patient...insurance and reliable transportation. + Two years as a Registered Nurse with at least one-year of… more
- Molina Healthcare (Atlanta, GA)
- …* At least 3 years health care management/leadership experience. * Registered Nurse (RN) or other advanced clinical or medical licensure. License must be ... active and unrestricted in state of practice. * Deep understanding of clinical operations: utilization management, care management, etc. * Ability to provide… more