- Elevance Health (Atlanta, GA)
- …prior authorization, and post service requests. + Refers cases requiring clinical review to a Nurse reviewer. + Responsible for the identification ... **Title: Utilization Management Representative I** **Location:** This position will...responsible for coordinating cases for precertification and prior authorization review . **How you will make an impact:** + Managing… more
- STG International (Milledgeville, GA)
- STGi is seeking a Licensed Practical Nurse /Licensed Vocational Nurse to provide services to our Georgia War Veterans Home. JOB SUMMARY: The primary purpose of ... FUNCTIONS: + Ensure the facility meets the minimum staffing levels for nurses and nurse aides; complete required posting of nursing staff data as required. + Ensure… more
- Immigration and Customs Enforcement (Folkston, GA)
- …Corps (IHSC), Office of Deputy Assistant Director of Clinical Services (DAD-CSU). The Nurse Manager (NM) will report directly to the Regional Nurse Manager ... ensuring needed interpretation and/or translations services are available. Reviews utilization and documentation of translation services within the medical record,… more
- PruittHealth (Fort Oglethorpe, GA)
- …years industry experience in a managed care setting focused on experience in utilization review /case management and at least two years case management, home ... **REGISTERED NURSE - CLINICAL CARE COORDINATOR 7am-7pm** **JOB PURPOSE:** Responsible...day to the receiving care setting * Coordinate with utilization management and hospital case management as needed for… more
- PruittHealth (Macon, GA)
- **JOB PURPOSE:** Senior Nurse Consultant serves as a member of the clinical and region team, to assist centers in achieving clinical excellence. She/he is ... operations and quality improvement practices for designated centers. The senior nurse consultant provides education, mentoring and validation of required systems and… more
- Fresenius Medical Center (College Park, GA)
- **PURPOSE AND SCOPE:** The professional registered nurse Outpatient RN CAP 2 may be an entry level designation into the Clinical Advancement Program (CAP) for new ... modifications to treatment plan as indicated and notifies Team Leader, Charge Nurse , Supervisor or Physician as needed. + Assesses, collaborates, and documents… more
- Fresenius Medical Center (Smyrna, GA)
- **PURPOSE AND SCOPE:** The professional registered nurse Home Therapies RN CAP 2 may be an entry level designation into the Clinical Advancement Program (CAP) for ... guidance from the Educator, Preceptor or in collaboration with another Registered Nurse . + Performs ongoing, systematic collection and analysis of dialysis data for… more
- Elevance Health (Columbus, GA)
- ** Nurse Appeals - Licensed RN Nurse ** **Location:** This position will work in a hybrid model (remote and office). Ideal candidates will live in Virginia, ... - 5:00 pm ET (will work weekends and holidays as needed). The ** Nurse Appeals** position is responsible for investigating and processing medical necessity appeals… more
- State of Georgia (Fulton County, GA)
- …experience in the analysis of medical services documentation and related claims 2) Utilization Review 3) Case Management 4) Analysis of CPT codes and/or ... Nurse Investigator Georgia - Fulton - Atlanta (https://careers.georgia.gov/jobs/51086/other-jobs-matching/location-only)...services, and appropriateness of services rendered based on chart review and client interview and assessment. + Maintains a… more
- US Tech Solutions (GA)
- …involve computer system data entry, data management, and reporting. + Review criteria-based prior authorizations following policy and procedure. + Provide on-call ... after hours nurse availability for...of related work experience. **Skills:** + Prior Authorization + Utilization Reeview **Education:** + High School Diploma or equivalent… more
- Fresenius Medical Center (Sharpsburg, GA)
- …auditing activities. + Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. + Manages clinic ... financials including efficient utilization of supplies or equipment and regular profits and...of supplies or equipment and regular profits and loss review . + Responsible for all required network reporting and… more
- Marriott (Atlanta, GA)
- …workers' compensation losses. The NCM is responsible for conducting first level Utilization Review and coordinates subsequent levels if necessary, as required ... **Additional Information** Nurse CARE Manager **Job Number** 24111133 **Job Category**...that may include multiple states. + Conducts first level utilization review per jurisdictional requirements. + Coordinates… more
- Evolent Health (Atlanta, GA)
- …. Develop processes where indicated with direct oversight of centralized telephonic review process of all necessary utilization management components. + Partner ... knowledge of utilization management activities such as prior authorization, concurrent review , intake, appeals and grievances - **Required** + Five (5) to seven… more
- ChenMed (Decatur, GA)
- …care and cost effectiveness through the integrating and functions of case management, utilization review and discharge planning. The incumbent in this role ... (RN, LPN or other nursing discipline) required + A minimum of 7 years' utilization review /case management experience, including psychological aspects of care + A… more
- CenterWell (Decatur, GA)
- …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and ... requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking...of Nursing. + Current state license as a Registered Nurse . + Proof of current CPR. + Valid driver's… more
- Veterans Affairs, Veterans Health Administration (Atlanta, GA)
- Summary The Atlanta VA Healthcare System is seeking an eligible Registered Nurse for the position of Deputy Chief of Quality and Patient Safety. Responsibilities ... Management Program External Reviews and Accreditation Surgical Quality Program Utilization Management Program Quality Consultant Programs In collaboration with the… more
- CenterWell (Atlanta, GA)
- …consulting with assigned nurse practitioners on management of complex patients. + Review all acute utilization events, with goal of reducing unnecessary ... operation, nights, and/or weekends.** This position will provide chart review for 3-5 hours per month. Additionally, this role...action. + Provide collaborating agreements for up to 4 nurse practitioners in the state of Georgia including but… more
- Humana (Atlanta, GA)
- …of UM Processes + Assist in the development, iteration, launch and utilization of tools/tracking mechanisms + Assist in the identification, creation, value ... and alternatives to ALC Alternative Level of Care (ALC) Front End Review (FER) Exclusions, and Independent Review Organization(IRO) language concessions +… more
- VIP Care (Atlanta, GA)
- …practicing interprofessional care delivery inclusive of Kroger pharmacists and dietitians. + Review and analyze TLC-determined claim and utilization data and ... week + Provide clinical supervision over four (4) Board Certified Family Nurse Practitioners Physician Roles and Responsibilities include, but are not limited to:… more
- HCA Healthcare (Savannah, GA)
- …management or critical care is preferred. + Certification in case management or utilization review is preferred. + InterQual experience is preferred. Memorial ... an organization that invests in you as a **Registered Nurse (RN) Case Manager** ? At **Memorial Health University...a difference. We are looking for a dedicated **Registered Nurse (RN) Case Manager** like you to be a… more