- 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
- Molina Healthcare (Atlanta, GA)
- …Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG ... guidelines. **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). **WORK SCHEDULE: Mon - Fri / Sun… 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 (Warner Robins, 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
- Fresenius Medical Center (Buford, 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
- 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
- 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
- HCA Healthcare (Savannah, GA)
- …**Introduction** Do you want to join an organization that invests in you as a Registered Nurse ( RN ) Case Manager? At Memorial Health University Medical ... make a difference. We are looking for a dedicated Registered Nurse ( RN ) Case Manager...or critical care is preferred. + Certification in case management or utilization review is… more
- HCA Healthcare (Savannah, GA)
- …**Introduction** Do you want to join an organization that invests in you as a Registered Nurse ( RN ) Case Manager? At Memorial Health University Medical ... make a difference. We are looking for a dedicated Registered Nurse ( RN ) Case Manager...or critical care is preferred. + Certification in case management or utilization review is… 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
- Molina Healthcare (Columbus, GA)
- …and production levels are maintained + Performs monthly auditing of registered nurse and other clinical functions in Utilization Management (UM), Case ... Management (CM), Member Assessment Team (MAT), Health Management (HM), and/or Disease Management (DM) and...them.. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse ( RN ) Program and… more
- CenterWell (Peachtree City, 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
- Humana (Atlanta, GA)
- …providers or members **Use your skills to make an impact** **Required Qualifications** + Licensed Registered Nurse ( RN ) in either Florida or a compact state ... us put health first** Job Description Summary The Pre-Authorization Nurse 2 reviews prior authorization requests for appropriate care...+ 2 or more years of Utilization Management (UM), Pre-Auth, and/or other managed care review… more
- Molina Healthcare (Savannah, GA)
- …Medical, or ER unit. **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). To all current Molina ... acute care/medical experience. **Required License, Certification, Association** Active, unrestricted State Registered Nursing ( RN ) license in good standing. Must… more
- Molina Healthcare (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
- 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
- Molina Healthcare (Atlanta, GA)
- … Registered Nursing ( RN ) license in good standing. + Utilization Management Certification (CPHM) Certified Professional in Health Care Quality (CPHQ), ... _Candidates must possess a current RN license, as well as a Bachelor's Degree_...Integrated DSNP Medicare and Medicaid model that ensures case management and utilization management work… more
- Trinity Health (Athens, GA)
- …for using Interqual criteria to perform initial admission reviews for the purpose of utilization review , coverage of services to be provided, as well as ... in an acute care setting and a minimum of 1 year in case management , utilization management , or discharge planning preferred. Certification in case… 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