- 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)
- **Title: Utilization Management Representative I** **Location:** This position will work a hybrid model (remote and office). Ideal candidates will live within 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
- STG International (Milledgeville, GA)
- STGi is seeking a Licensed Practical Nurse /Licensed Vocational Nurse to provide services to our Georgia Ware Veterans Home. JOB SUMMARY: The primary purpose of ... FUNCTIONS: + Ensure the facility meets the minimum staffing levels for nurses and nurse aides; complete required posting of nursing staff data as required. + Ensure… 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
- Immigration and Customs Enforcement (Folkston, GA)
- …Corps (IHSC), Office of Deputy Assistant Director of Clinical Services (DAD-CSU). The Nurse Manager (NM) will report directly to the Regional Nurse Manager ... ensuring needed interpretation and/or translations services are available. Reviews utilization and documentation of translation services within the medical record,… 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 ... payment. May also manage appeals for services denied ,** **continued stay review , care coordination, and discharge planning for appropriateness of treatment setting… 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
- Prime Therapeutics (Atlanta, GA)
- …of post-degree clinical experience. + Experience in managed care, specialty drugs, care management and utilization review . + Meets Magellan Credentialing ... and drives every decision we make. **Job Posting Title** Infusion Referral Nurse - REMOTE **Job Description Summary** Under supervision, is responsible for performing… 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 ... **Telephonic Nurse Case Manager II** **Location: This is a...claims or service issues. + Assists with development of utilization /care management policies and procedures. **Minimum Requirements:**… 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 ... **Telephonic Nurse Case Manager II** **Location: This is a...claims or service issues. + Assists with development of utilization /care management policies and procedures. **Minimum Requirements:**… 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
- US Tech Solutions (GA)
- …information is necessary and will involve computer system data entry, data management , and reporting. + Review criteria-based prior authorizations following ... policy and procedure. + Provide on-call after hours nurse availability for urgent PA requests. + Provide internal nurse support to the PA team and member… more
- Fresenius Medical Center (Vidalia, 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
- Sedgwick (Atlanta, GA)
- …and consult review ; and two (2) years of experience in daily application of nurse auditing, utilization review and bill review . **Skills & ... Great Place to Work(R) Most Loved Workplace(R) Forbes Best-in-State Employer RN Bill Review **PRIMARY PURPOSE** **:** To review hospital and professional medical… more
- ChenMed (Decatur, GA)
- …of care and cost effectiveness through the integrating and functions of case management , utilization review and discharge planning. The incumbent in ... related field preferred + Valid, active licensure as professional nurse (RN, LPN or other nursing discipline) required +...nursing discipline) required + A minimum of 7 years' utilization review /case management experience, including… more
- GetWellNetwork, Inc. (Dublin, GA)
- …Manager will take the Get Well program to the next level by driving nurse engagement, focusing on increased utilization , and leading projects of functionality to ... Well's Client Success Manager is responsible for effective product utilization and successful outcomes for the Get Well system...of the Get Well system by conducting quarterly account review meetings pertaining to account roadmap; conduct nurse… more
- CenterWell (Brunswick, GA)
- …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and ... requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking...and reliable transportation. + Two years as a Registered Nurse with at least one-year of management … more