- Humana (Atlanta, GA)
- **Become a part of our caring community and help us put health first** The Utilization Management Registered Nurse 2 utilizes clinical nursing skills to ... independent determination of the appropriate courses of action. The Utilization Management Registered Nurse...skills to make an impact** **Required Qualifications** + **Licensed Registered Nurse ( RN )** in the… 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...skills to make an impact** **Required Qualifications** + Licensed Registered Nurse ( RN ) Compact license… more
- Elevance Health (Atlanta, GA)
- …within 50 miles of an Elevance Health Pulse Point. The ** Nurse Medical Management II - Utilization Management ** is responsible to collaborate with ... and initiatives. **Minimum Requirements:** + Requires current active unrestricted RN license to practice as a health professional in...of 3 years acute care clinical experience or case management , utilization management or managed… more
- Humana (Atlanta, GA)
- …related to Utilization Management and/or Behavioral Health. + Registered Nurse or Behavioral Health Licensed Professional. + Managed care, Medicaid ... + Minimum 3 years of experience in NCQA Health Plan Accreditation and/or Utilization Management + Exceptional attention to detail. + Demonstrated excellent time… more
- Fresenius Medical Center (Lawrenceville, GA)
- …and acts as the liaison for patient care as per the disease management agreement, including initial and ongoing validation of member eligibility. Facilitate timely ... workup of patients for access management , dialysis services, patient education, hospitalizations, and kidney transplantation as appropriate, and ensures coordination… more
- Elevance Health (Atlanta, GA)
- …equivalent and a minimum of 3 years acute care clinical experience or case management , utilization management or managed care experience; or any combination ... ensure medically appropriate, high quality, cost effective care throughout the medical management process. + Collaborates with providers to assess members needs for… more
- CVS Health (Atlanta, GA)
- …**.** This role is a blended role doing both Case Management and Utilization Management . The RN Case Manager is responsible for telephonically and/or ... 5 years clinical practice experience as an RN + 6+ months Case Management or Utilization Management experience + Must be willing and able to work Monday… more
- Veterans Affairs, Veterans Health Administration (Atlanta, GA)
- …or Scope of Assigned Duties: The Nurse Employee Occupational Health (EOH) Registered Nurse ( RN ) is responsible for providing competent, evidence-based ... education, orientation, competencies and providing quality improvement and outcomes utilization consultation. The EOH RN contributes to...level degree in Nursing may have opportunity to become registered as a nurse with a state… more
- Fresenius Medical Center (Decatur, GA)
- …under the direction of the Facility Manager, Director of Nursing and/or Charge Registered Nurse , utilizing standard nursing techniques to assist the physician in ... on adverse events and action thresholds in collaboration with facility management . + Maintains integrity of medical records and other organization administrative… more
- ChenMed (Decatur, GA)
- …We're rapidly expanding and we need great people to join our team. The Registered Nurse , Virtual Care is responsible for providing telephonic triage directional ... issues, client counseling, patient advocacy, health education and referral and resource management to ChenMed patients and their families. The incumbent in this role… more
- ChenMed (Atlanta, GA)
- …of care and cost effectiveness through the integrating and functions of case management , utilization review and discharge planning. The incumbent in this role ... degree in a healthcare related field preferred + Valid, active licensure as professional nurse ( RN , LPN or other nursing discipline) required + A minimum of… more
- Humana (Atlanta, GA)
- …SQL + Graduate degree + Utilization Management Review Experience + Registered Nurse ( RN ) Credentials + Home Health, Durable Medical Equipment, and/or ... Skilled Nursing Facility Experience **Additional Information** **Scheduled Weekly Hours** 40 **Pay Range** The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …policies and procedures. Minimum Qualifications: + Must have a valid, active unencumbered Registered Nurse license or temporary permit approved by the Georgia ... programs + And more **Description** We're seeking an **Assistant Manager, Utilization Review** , responsible for supervising and coordinating activities of personnel… more
- Elevance Health (Atlanta, GA)
- …states or territory of the United States required. + Previous experience in case management / utilization management with a broad range of experience with ... which would provide an equivalent background + Current active unrestricted license such as RN LCSW LMSW LMHC LPC LBA (as allowed by applicable state laws) LMFT or… more
- Morehouse School Of Medicine (Atlanta, GA)
- …long-term stages of illness for defined patient populations. This includes utilization management , transitional care planning, psychosocial and functional status ... The Care Coordinator's primary responsibilities are to facilitate care management and coordination of clinical activities for chronically ill...Manager), CSS (Community Support Specialist), CMA , LPN , RN , NP, LPC , LCSW , or other approved… more
- Elevance Health (Atlanta, GA)
- …- 8:00pm ET The ** Nurse Case Manager II** is responsible for care management within the scope of licensure for members with complex and chronic care needs by ... with providers, claims or service issues. + Assists with development of utilization /care management policies and procedures. **Minimum Requirements:** + Requires… more
- Elevance Health (Atlanta, GA)
- …required.** The **Telephonic Nurse Case Manager II** is responsible for care management within the scope of licensure for members with complex and chronic care ... **Telephonic Nurse Case Manager II** **Location: This is a...claims or service issues. + Assists with development of utilization /care management policies and procedures. **Minimum Requirements:**… more
- Elevance Health (Atlanta, GA)
- …required.** The **Telephonic Nurse Case Manager II** is responsible for care management within the scope of licensure for members with complex and chronic care ... **Telephonic Nurse Case Manager II** **Location: This is a...claims or service issues. + Assists with development of utilization /care management policies and procedures. **Minimum Requirements:**… more
- CenterWell (Stockbridge, GA)
- …license, auto insurance and reliable transportation. + Two years as a Registered Nurse with at least one-year of management experience in a home care, ... sit on-site at our Stockbridge, GA branch location.** The ** RN Clinical Manager** coordinates and oversees all direct care...School of Nursing. + Current state license as a Registered Nurse . + Proof of current CPR.… more
- Elevance Health (Atlanta, GA)
- …with providers, claims or service issues. + Assists with development of utilization /care management policies and procedures. **Requirements:** + BA/BS in a ... Monday-Thursday 10:00am-6:00pm EST , Friday 11:30am-8:00pm EST **Responsible for care management within the scope of licensure for members with complex and… more