- Humana (Atlanta, GA)
- …documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are ... a part of our caring community and help us put health first** The Utilization Management Registered Nurse 2 utilizes clinical nursing skills to support the… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …programs + And more **Description** We're seeking an **Assistant Manager, Utilization Review ** , responsible for supervising and coordinating activities ... of personnel in the Utilization Review Department, including: + Staff schedules...Qualifications: + Must have a valid, active unencumbered Registered Nurse license or temporary permit approved by the Georgia… more
- Lincoln Financial Group (Atlanta, GA)
- …Experience and/or proficiency with Disability Management (STD/LTD) knowledge, Workers Compensation, Utilization Review and/or nurse case management ... Role at a Glance** We are excited to bring on a highly motivated Nurse Disability Consultant to our clinical organization. This position will be responsible for… more
- Centene Corporation (Atlanta, GA)
- …adherence to performance, compliance, quality, and efficiency standards + Collaborates with utilization management team to resolve complex care member issues + ... knowledge of regulations, accreditation standards, and industry best practices related to utilization management + Works with utilization management… more
- Elevance Health (Atlanta, GA)
- **Anticipated End Date:** 2024-09-13 **Position Title:** Utilization Management Rep I **Job Description:** **Title: Utilization Management Representative ... 50 miles of one of our PulsePoint locations. The ** Utilization Management Representative I** will be responsible...and post service requests. + Refers cases requiring clinical review to a Nurse reviewer. + Responsible… more
- Humana (Atlanta, GA)
- …and ad hoc reports in Access and/or 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)… more
- Humana (Atlanta, GA)
- …**Preferred Qualifications** + Registered Nurse + Experience in Medicare Utilization Management + Project Management Professional (PMP) certification ... are addressed. They will work closely with established functions inside utilization management (Medical Director, clinician decision making teams, quality… 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 ... **Anticipated End Date:** 2024-08-28 **Position Title:** Nurse Medical Management Sr **Job Description:**...also manage appeals for services denied ,** **continued stay review , care coordination, and discharge planning for appropriateness of… more
- Elevance Health (Atlanta, GA)
- …health insurance/benefits, medical management process, care management , and utilization review management strongly preferred. For candidates working ... Case Manager II** is responsible for the Case Management and Utilization Management of...Management Exempt **Workshift:** **Job Family:** MED > Licensed Nurse Please be advised that Elevance Health only accepts… more
- Veterans Affairs, Veterans Health Administration (Atlanta, GA)
- …by the VHA Education Loan Repayment Services program office after complete review of the EDRP application. Responsibilities This is an OPEN CONTINUOUS ANNOUNCEMENT ... Assumes responsibility for the coordination of care focused on education, self- management , and customer satisfaction throughout the continuum of care. Administers… more
- PruittHealth (Norcross, 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
- Elevance Health (Atlanta, GA)
- …with providers, claims or service issues. + Assists with development of utilization /care management policies and procedures. **Minimum Requirements:** + Requires ... Level:** Non- Management Exempt **Workshift:** **Job Family:** MED > Licensed Nurse Please be advised that Elevance Health only accepts resumes for compensation… 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 ... with providers, claims or service issues. + Assists with development of utilization /care management policies and procedures. **Minimum Requirements:** + Requires… more
- State of Georgia (Fulton County, GA)
- …additional experience in the analysis of medical services documentation and related claims 2) Utilization Review 3) Case Management 4) Analysis of CPT codes ... 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
- 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
- ChenMed (Atlanta, GA)
- …of care and cost effectiveness through the integrating and functions of case management , utilization review and discharge planning. The incumbent in ... related field preferred + Valid, active licensure as professional nurse (RN, LPN or other nursing discipline) required +...nursing discipline) required + A minimum of 7 years' utilization review /case management experience, including… more
- CenterWell (Stockbridge, 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...and reliable transportation. + Two years as a Registered Nurse with at least one-year of management … more
- Elevance Health (Atlanta, GA)
- …**How you will make an impact:** + Develops, maintains and enhances the claims review process. + Assists management with developing unit goals, policies and ... Level:** Non- Management Exempt **Workshift:** **Job Family:** MED > Licensed Nurse Please be advised that Elevance Health only accepts resumes for compensation… more
- Cardinal Health (Atlanta, GA)
- …for physician leaders and physician board regarding all areas of practice management and operations. This leader has primary responsibility to manage and drive ... will be needed in the following areas: practice operations, revenue cycle management , patient growth and practice marketing, value-based care, payor relations, EHR,… more