- Humana (Atlanta, GA)
- …of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, ... determination of the appropriate courses of action. The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and independent… more
- Cognizant (Atlanta, GA)
- …+ Educational background - Registered Nurse (RN) + 2-3 years combined clinical and/or utilization management experience with managed health care plan ... Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced...care revenue cycle or clinic operations + Experience in utilization management to include Clinical … more
- Waystar (Atlanta, GA)
- **ABOUT THIS POSITION** The Clinical Product Consultant for Utilization Management is a member of the Customer Success Organization who will provide ... best practice workflows. We are specifically seeking an experienced Utilization Review Nurse who will serve as...acute care setting + 2+ years of experience in utilization management + Knowledge and understanding of… more
- Elevance Health (Atlanta, GA)
- **Title: Utilization Management Representative I** **Virtual:** This role enables associates to work virtually full-time, with the exception of required ... an accommodation is granted as required by law._ The ** Utilization Management Representative I** will be responsible...authorization, and post service requests. + Refers cases requiring clinical review to a Nurse reviewer. +… more
- Molina Healthcare (Atlanta, GA)
- …hearing officer during fair hearings as may be required. * Serves as a clinical resource for utilization management , chief medical officer, physicians, and ... JOB DESCRIPTION **Job Summary** The RN Clinical Appeals Nurse provides support for...officer on denial decisions. * Resolves escalated complaints regarding utilization management and long-term services and supports… more
- Evolent (Atlanta, GA)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. ... physician-developed medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care… more
- Fresenius Medical Center (Atlanta, GA)
- **About this role:** As a Clinical Manager with Fresenius Medical Care, you will ensure that quality patient care is delivered while maintaining clinical ... or chronic kidney disease. **Training and advancement:** You will enter our Clinical Leadership Program that creates and supports a culture of continuous learning… more
- ChenMed (Decatur, GA)
- …position may require participation in risk and quality management programs, clinical meetings and other meetings. The Nurse Practitioner, Specialty incumbent ... of practice + A minimum of 3 years experience working in Cardiology as a Nurse Practitioner in an out-patient clinical setting + Basic Life Support (BLS)… more
- CVS Health (Atlanta, GA)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... self-insured clients. + Application and/or interpretation of applicable criteria and clinical guidelines, standardized care management plans, polices, procedures… more
- Elevance Health (Atlanta, GA)
- …solving with providers, claims or service issues. + Assists with development of utilization /care management policies and procedures. + Within the medical ... **Transplant Nurse II** **Location:** Virtual: This role enables associates...II** will be responsible for providing case and/or medical management for members receiving transplant services. Continue to learn… more
- ChenMed (Decatur, GA)
- …expanding and we need great people to join our team. The Registered Nurse , Care Line, is responsible for providing telephonic triage directional patient care advice ... client counseling, patient advocacy, health education and referral and resource management to ChenMed patients and their families. Providing on-call coverage, the… more
- Evolent (Atlanta, GA)
- …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and ... accomplishments. **What You Will Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to company… 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** **Sign on Bonus: $2000.**...claims or service issues. + Assists with development of utilization /care management policies and procedures. **Minimum Requirements:**… more
- Elevance Health (Atlanta, GA)
- …with providers, claims or service issues. + Assists with development of utilization /care management policies and procedures. **Minimum Requirements:** + Requires ... **Telephonic Nurse Case Manager I** **Location: This role enables... Case Manager I** is responsible for telephonic care management within the scope of licensure for members with… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …+ And more **Description** We're seeking an **Transfer Center Registered Nurse is** responsible for accepting incoming referral information via multimedia and ... working directly with bed management and direct care nursing to coordinate inpatient bed...Coordinates, prioritizes, and optimizes patient flow using knowledge of clinical and operational activities throughout the hospital network. +… more
- CenterWell (Marietta, GA)
- …driver's license, auto insurance and reliable transportation. + Two years as a Registered Nurse with at least one-year of management experience in a home care, ... caring community and help us put health first** The Clinical Manager, Home Health Nursing enables patients to stay... documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates… more
- CenterWell (Atlanta, GA)
- …with scheduled hours starting Friday evening through Monday morning to support clinical operations across multiple home health branch locations.** The **RN Weekend ... Clinical Manager** provides weekend oversight and clinical ... documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates… more
- CVS Health (Atlanta, GA)
- …empowered to: + Deliver forward-thinking clinical insights derived from analyzing clinical utilization patterns and member behavior impact on medical costs. ... CPC, you will collaborate closely with account teams, care management , Regional Analytic Consulting, and key enterprise partners to...nurse (RN) license + Minimum 5 years of clinical experience + At least 3 years in acute… more
- Philips (Alpharetta, GA)
- …etc) with clinical experience as Radiologic Technologist (RT) or Registered Nurse (RN) highly preferred. + Experience in healthcare (in the hospital) within ... **Sales Support, Clinical Specialist - FORS (West/National Travel)** In this...to effectively manage assigned accounts in terms of driving utilization , customer relationship management , problem resolution, etc.… more
- Molina Healthcare (Atlanta, GA)
- …of health care services provided to plan members. * Supports plan utilization management program and accompanying action plan(s), which includes strategies ... the most appropriate care at the most effective setting. *Evaluates effectiveness of utilization management (UM) practices - actively monitoring for over and… more