- GHR Healthcare (Atlanta, GA)
- …making critical decisions that impact patient care? Join us as a Care Management Coordinator and play a key role in evaluating and authorizing essential healthcare ... Pay Rate: 37.50 -40.00 Hourly (paid weekly) What You'll Do: Clinical Analysis: Review medical records to determine the necessity of patient services based on… more
- Northeast Georgia Health System, Inc (Braselton, GA)
- Job Category:Nursing - Registered Nurse Work Shift/Schedule:8 Hr Morning - AfternoonNortheast Georgia Health System is rooted in a foundation of improving the health ... Center of Excellence in Minimally Invasive Surgery and Robotic Job SummaryThe Nurse Manager (NM) functions as the first-line administrative nursing leader, with… more
- Northeast Georgia Health System, Inc (Oakwood, GA)
- …to ensure appropriate feedback is received before product decisions are made. Utilization Review of necessity, quality, effectiveness and efficiency of medical ... Job Category:Nursing - Registered Nurse Work Shift/Schedule:8 Hr Morning - AfternoonNortheast Georgia Health System is rooted in a foundation of improving the health… more
- Pacer Staffing (Atlanta, GA)
- … Utilization Review Certification or Certified Professional Utilization Management Certification Experience in UM policy writing, development, ... Job Description: Summary: This individual contributor position reports to the Directors of Utilization Management (UM) and Referral Management (RM) and… more
- Pacer Staffing (Atlanta, GA)
- …description Job Summary This individual contributor position reports to the Directors of Utilization Management (UM) and Referral Management (RM) and ... Nurse , with current unrestricted license in appropriate state . 4+ years Utilization Management experience . Proficient at in-depth analysis of clinical… more
- Pacer Staffing (Atlanta, GA)
- …regulatory requirements, and HIPAA privacy regulations. . Thorough knowledge of Case Management , Utilization Management , HIPAA Privacy and Security ... Job Summary . Provides Disease Management (DM) services to TRICARE beneficiaries. . The... (DM) services to TRICARE beneficiaries. . The DM nurse will collaboratively assess, plan, implement, coordinate, monitor and… more
- Pacer Staffing (Atlanta, GA)
- …direction and build group engagement. Technical Skills: Thorough knowledge of Case Management , Utilization Management , TRICARE policies and procedures, HIPAA ... serious disabilities, physical disabilities.) Job Summary: The position provides case management services for TRICARE beneficiaries registered in the Extended Care… more
- Humana (Atlanta, GA)
- …documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are ... a part of our caring community and help us put health first** The Utilization Management Registered Nurse 2 utilizes clinical nursing skills to support the… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …programs + And more **Description** We're seeking an **Assistant Manager, Utilization Review ** , responsible for supervising and coordinating activities ... of personnel in the Utilization Review Department, including: + Staff schedules...Qualifications: + Must have a valid, active unencumbered Registered Nurse license or temporary permit approved by the Georgia… more
- Lincoln Financial Group (Atlanta, GA)
- …Experience and/or proficiency with Disability Management (STD/LTD) knowledge, Workers Compensation, Utilization Review and/or nurse case management ... Role at a Glance** We are excited to bring on a highly motivated Nurse Disability Consultant to our clinical organization. This position will be responsible for… more
- Centene Corporation (Atlanta, GA)
- …adherence to performance, compliance, quality, and efficiency standards + Collaborates with utilization management team to resolve complex care member issues + ... knowledge of regulations, accreditation standards, and industry best practices related to utilization management + Works with utilization management… more
- Elevance Health (Atlanta, GA)
- **Anticipated End Date:** 2024-09-13 **Position Title:** Utilization Management Rep I **Job Description:** **Title: Utilization Management Representative ... 50 miles of one of our PulsePoint locations. The ** Utilization Management Representative I** will be responsible...and post service requests. + Refers cases requiring clinical review to a Nurse reviewer. + Responsible… more
- Humana (Atlanta, GA)
- …and ad hoc reports in Access and/or SQL + Graduate degree + Utilization Management Review Experience + Registered Nurse (RN) Credentials + Home Health, ... Durable Medical Equipment, and/or Skilled Nursing Facility Experience **Additional Information** **Scheduled Weekly Hours** 40 **Pay Range** The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week)… more
- Humana (Atlanta, GA)
- …**Preferred Qualifications** + Registered Nurse + Experience in Medicare Utilization Management + Project Management Professional (PMP) certification ... are addressed. They will work closely with established functions inside utilization management (Medical Director, clinician decision making teams, quality… more
- Elevance Health (Atlanta, GA)
- …equivalent and a minimum of 3 years acute care clinical experience or case management , utilization management or managed care experience; or any combination ... **Anticipated End Date:** 2024-08-28 **Position Title:** Nurse Medical Management Sr **Job Description:**...also manage appeals for services denied ,** **continued stay review , care coordination, and discharge planning for appropriateness of… more
- Elevance Health (Atlanta, GA)
- …health insurance/benefits, medical management process, care management , and utilization review management strongly preferred. For candidates working ... Case Manager II** is responsible for the Case Management and Utilization Management of...Management Exempt **Workshift:** **Job Family:** MED > Licensed Nurse Please be advised that Elevance Health only accepts… more
- Veterans Affairs, Veterans Health Administration (Atlanta, GA)
- …by the VHA Education Loan Repayment Services program office after complete review of the EDRP application. Responsibilities This is an OPEN CONTINUOUS ANNOUNCEMENT ... Assumes responsibility for the coordination of care focused on education, self- management , and customer satisfaction throughout the continuum of care. Administers… more
- PruittHealth (Norcross, 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
- Elevance Health (Atlanta, GA)
- …with providers, claims or service issues. + Assists with development of utilization /care management policies and procedures. **Minimum Requirements:** + Requires ... Level:** Non- Management Exempt **Workshift:** **Job Family:** MED > Licensed Nurse Please be advised that Elevance Health only accepts resumes for compensation… 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 ... with providers, claims or service issues. + Assists with development of utilization /care management policies and procedures. **Minimum Requirements:** + Requires… more
