- Centene Corporation (Atlanta, GA)
- …findings, discharge plans, and actions taken on member medical records in health management systems according to utilization management policies and ... preferred. Knowledge of Medicare and Medicaid regulations preferred. Knowledge of utilization management processes preferred. **License/Certification:** + LPN -… more
- Molina Healthcare (Atlanta, GA)
- …of payment decisions. + Serves as a clinical resource for Utilization Management , Chief Medical Officers, Physicians, and Member/Provider Inquiries/Appeals. ... SKILLS & ABILITIES:** + Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years… more
- Elevance Health (Atlanta, GA)
- …schedule.** **Build the Possibilities. Make an Extraordinary Impact.** The **Medical Management Nurse ** is responsible for the review of the most complex or ... **Be Part of an Extraordinary Team** **Medical Management Nurse ** **Location: Remote-** Candidates must...experience and requires a minimum of 2 years clinical, utilization review , or managed care experience; or… more
- PruittHealth (Atlanta, 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
- CVS Health (Atlanta, GA)
- …information is necessary and will involve computer system data entry, data management , and reporting. - Review criteria-based prior authorizations following ... and will not be patient facing. The Licensed Practical Nurse (LPN) or Licensed Vocational Nurse (LVN)...assignments as delegated by the PA leadership team. - Utilization of clinical skills to support the documentation and… more
- Elevance Health (Atlanta, GA)
- **Medical Management Nurse ** **Federal Employee Program - FEP** , a proud member of the Elevance Health, Inc. family of companies, it is a powerful combination, ... pm (EST) shift rotation twice a month.** The **Medical Management Nurse ** is responsible for reviewing the...experience and requires a minimum of 2 years clinical, utilization review , or managed care experience; or… more
- Elevance Health (Atlanta, GA)
- …in an ambulatory or hospital setting or minimum of 1 year of prior utilization management , medical management and/or quality management , and/or ... required. **Preferred Skills, Capabilities, and Experiences** **:** + Familiarity with Utilization Management Guidelines, ICD-9 and CPT-4 coding, and managed… 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/64040/other-jobs-matching/location-only)...services, and appropriateness of services rendered based on chart review and client interview and assessment. + Maintains a… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …for all EHC operating units, coordinating room assignments to optimize bed utilization across the health system, critically thinking to manage appropriate patient ... of care. Uses advanced clinical knowledge and medical chart review to direct proper patient placement at each operating...patient placement at each operating unit. + Supports efficient utilization of EHC beds in accordance with established health… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …**Bed Planning Coordinator** responsible for efficiently managing patient flow and bed utilization across all EHC operating units. This professional will apply their ... and department protocols to balance patient volumes, support system-wide bed management , and collaborate with multidisciplinary teams to overcome flow barriers. This… more
- Fresenius Medical Center (Lithonia, 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
- Evolent (Atlanta, GA)
- …for operational performance of physician, nursing, and shared services staff in the utilization management value chain + Owns clinical rationale for ... point of responsibility for all clinical operations inclusive of nurse , physician, and shared services performance. and core work...utilization management decisions made by all clinical staff + Ensures… more
- CenterWell (Sandy Springs, 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
- PruittHealth (Norcross, GA)
- …and in ensuring appropriate data elements are included in the POC. + Review visit utilization for appropriateness as per care guidelines, best practices, ... Coordination (DEAC), the Episode Assessment Coordinator (EAC) is responsible for prospective review of episode related documents. The EAC ensures all services and… more
- Molina Healthcare (Atlanta, GA)
- …Active, unrestricted State Registered Nursing (RN) license in good standing. + Utilization Management Certification (CPHM) Certified Professional in Health Care ... and results across Molina Health Plans & Segments. **KNOWLEDGE/SKILLS/ABILITIES** + Review existing case management standards and processes and establishes… more