- Elevance Health (Columbus, GA)
- ** Nurse Appeals - Licensed RN Nurse ** **Location:** This position will work in a hybrid model (remote and office). Ideal candidates will live in Virginia, ... 5:00 pm ET (will work weekends and holidays as needed). The ** Nurse Appeals ** position is responsible for investigating and processing medical necessity … more
- PruittHealth (Norcross, GA)
- …knowledge and ability to manage the Medicare and Medicaid denials and appeals process. + 6. Demonstrates ability to perform and document audits, including ... with other partners. **LICENSURE, CERTIFICATION AND EDUCATION REQUIREMENTS:** + Must be a Registered Nurse in good standing in at least one of the states in which… more
- Evolent Health (Atlanta, GA)
- …review of prior authorization requests and support additional features such as training, appeals , and grievances for clients who have delegated UM. + Monitor all ... with the utilization management department, including but not limited to claims, appeals , product, network development and care management. + Provide appropriate and… more