• Medical Claim Review

    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
    Molina Healthcare (01/25/25)
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  • Nurse Investigator

    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
    State of Georgia (12/20/24)
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  • Diagnosis Related Group Clinical Validation…

    Elevance Health (Atlanta, GA)
    …experience preferred. + Broad knowledge of clinical documentation improvement guidelines, medical claims billing and payment systems, provider billing ... more
    Elevance Health (01/01/25)
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  • Nurse /CPC - Clinical Fraud Investigator…

    Elevance Health (Atlanta, GA)
    ** Nurse /CPC - Clinical Fraud Investigator Senior - SIU Fraud...control. + Review and conducts analysis of claims and medical records prior to payment. + ... more
    Elevance Health (02/13/25)
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  • Clinical Appeals Nurse (RN): Texas and New…

    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
    Molina Healthcare (02/09/25)
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  • Telephonic Nurse Case Manager II

    Elevance Health (Atlanta, GA)
    **Telephonic Nurse Case Manager II** **Location: This is a virtual position. Candidates must reside within 50 miles of an Elevance Health Pulse Point location.** ... more
    Elevance Health (02/13/25)
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  • Initial Review Pharmacy Technician

    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
    Prime Therapeutics (02/12/25)
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  • Payment Integrity Clinician - RN (Remote)

    Highmark Health (Atlanta, GA)
    review basis. Review process includes a review of medical documentation, itemized bills, and claims data to assure appropriate level of payment and ... more
    Highmark Health (02/13/25)
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  • Medical Director (Medicare)

    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 (02/09/25)
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  • Medical Director (Marketplace)

    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 (02/06/25)
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  • Project Sourcing Manager (PSM)

    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
    GE Vernova (02/08/25)
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  • Special Investigation Unit Manager Clinical…

    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
    CVS Health (12/25/24)
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  • Commodity Site Leader (m/f/d)

    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
    GE Vernova (01/21/25)
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