- 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
- 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
- Highmark Health (Atlanta, GA)
- …and Sunday required in addition to 3 weekdays** This job implements effective utilization management strategies including: review of appropriateness of ... and offers interventions and/or alternatives. **ESSENTIAL RESPONSIBILITIES** + Implement care management review processes that are consistent with established… more
- Sharecare (Atlanta, GA)
- …appropriate total healthcare management and ensure cost effective, appropriate resource utilization and quality outcomes. The RN is also responsible for ... and their Primary Care Provider according to the disease management program intervention guidelines. An RN is...orientation and to take the pre and posttests to review competency during orientation. Yearly competency test is required… 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 ... flow, working closely with the Transfer Services RN Coordinator and Patient Flow Coordinator to manage the...of care. Uses advanced clinical knowledge and medical chart review to direct proper patient placement at each operating… more
- Highmark Health (Atlanta, GA)
- …Remote - Part Time - Weekends Required.** This job implements the effective utilization management strategies including: review of appropriateness of health ... and offers interventions and/or alternatives. **ESSENTIAL RESPONSIBILITIES:** + Implement care management review processes that are consistent with established… more
- CenterWell (Sandy Springs, 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, ... clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the...School of Nursing. + Current state license as a Registered Nurse . + Proof of current CPR.… more
- PruittHealth (Norcross, GA)
- …credentials will be considered. **MINIMUM LICENSURE/CERTIFICATION REQUIRED:** + Current and unrestricted Registered Nurse ( RN ) licensure in state of ... and in ensuring appropriate data elements are included in the POC. + Review visit utilization for appropriateness as per care guidelines, best practices,… more
- Molina Healthcare (Atlanta, GA)
- … Registered Nursing ( RN ) license in good standing. + Utilization Management Certification (CPHM) Certified Professional in Health Care Quality (CPHQ), ... and results across Molina Health Plans & Segments. **KNOWLEDGE/SKILLS/ABILITIES** + Review existing case management standards and processes and establishes… more
- CVS Health (Atlanta, GA)
- … states. This role is a blended role doing both Case Management and Utilization Management . The RN Case Manager is responsible for telephonically and/or ... personal, convenient and affordable. **Position Summary** This Case Manager RN position is with Aetna's National Medical Excellence (NME)...years' experience in critical care - 6+ months Case Management or Utilization Management experience… more
- Guardian Life (Atlanta, GA)
- …services. Act as a liaison between all parties required in case management to facilitate collaboration toward RTW goals. Utilization of independent ... **Position Summary** The RN Clinical Consultant serves as a clinical resource...issues, when possible, to enhance the customer experience. **Activity** Review and assess claimant subjective reports and objective medical… more
- Actalent (Dunwoody, GA)
- …to think critically and problem-solve To be considered for this role you must possess a Registered Nurse ( RN ) license in the state of Georgia, a minimum of ... orders, care paths, etc. for patient care. Skills case management , inpatient, Hospital, Medical Center, RN , ...of case management experience, and experience in utilization review or quality assurance. Experience Level… 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
- Evolent (Atlanta, GA)
- …Doing:** As a Clinical Reviewer, Nurse , you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... Clinical Reviewers are supported by Field Medical Directors (MDs) in the utilization management determination process. + Reviews charts and analyzes clinical… more
- Fresenius Medical Center (College Park, GA)
- …auditing activities. + Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. + Manages clinic ... financials including efficient utilization of supplies or equipment and regular profits and...of supplies or equipment and regular profits and loss review . + Responsible for all required network reporting and… more
- Elevance Health (Atlanta, GA)
- …for managing the clinical operations department. Manages the delivery of quality care management , clinical utilization and referral services. **How you will make ... practice that is relevant to the clinical areas under review . + Identifies areas for quality improvement and implements...unrestricted license in a mental health field as an RN , PhD, LCSW (as applicable by state law and… more