- Molina Healthcare (Atlanta, GA)
- …Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years of experience in ... more
- Elevance Health (Atlanta, GA)
- **Clinical Review Nurse II** National Government Services is a proud member of Elevance Health's family of brands. We administer government contracts for ... 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 ... more
- Elevance Health (Atlanta, GA)
- …experience preferred. + Broad knowledge of clinical documentation improvement guidelines, medical claims billing and payment systems, provider billing ... more
- Molina Healthcare (Atlanta, GA)
- …Managed Care Experience in the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and Support, ... more
- Elevance Health (Atlanta, GA)
- ** Nurse /CPC - Clinical Fraud Investigator II - SIU...control. + Review and conducts analysis of claims and medical records prior to payment. ... more
- Prime Therapeutics (Atlanta, GA)
- …staff, cardholders, and pharmacies. + Escalates medical exception requests to nurse , pharmacist or physician on the utilization review clinical team when ... more
- Molina Healthcare (Atlanta, GA)
- …retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. + Attends or chairs committees as required such as ... more
- Molina Healthcare (Atlanta, GA)
- …retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. + Attends or chairs committees as required such as ... more
- GE Vernova (Atlanta, GA)
- …the purchase orders within budget * Supports Commodity Manager in contract claim management and ensures vendor recovery * Supports GCL/CSL/Buyer in invoices release, ... more
- PruittHealth (Norcross, GA)
- …Coordination (DEAC), the Episode Assessment Coordinator (EAC) is responsible for prospective review of episode related documents. The EAC ensures all services and ... more
- CVS Health (Atlanta, GA)
- …Plans. Coordinates and arranges for health care service delivery under the direction of nurse or medical director in the most appropriate setting at the most ... more
- CVS Health (Atlanta, GA)
- …Direct and oversee complex reviews. Ensure timely and accurate reporting of review findings and coordinate with investigative to take appropriate action. Conducts ... more
- GE Vernova (Atlanta, GA)
- …Negotiate terms and conditions and transmit information to Procurement. Manage claims . Includes commercial sourcing management such as data analysis, negotiations ... more