- Elevance Health (Atlanta, GA)
- …prior authorization, and post service requests. + Refers cases requiring clinical review to a Nurse reviewer. + Responsible for the identification ... **Title: Utilization Management Representative I** **Location:** This position will...responsible for coordinating cases for precertification and prior authorization review . **How you will make an impact:** + Managing… more
- STG International (Milledgeville, GA)
- STGi is seeking a Licensed Practical Nurse /Licensed Vocational Nurse to provide services to our Georgia War 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
- 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
- PruittHealth (Fort Oglethorpe, GA)
- …years industry experience in a managed care setting focused on experience in utilization review /case management and at least two years case management, home ... **REGISTERED NURSE - CLINICAL CARE COORDINATOR 7am-7pm** **JOB PURPOSE:** Responsible...day to the receiving care setting * Coordinate with utilization management and hospital case management as needed for… more
- PruittHealth (Macon, 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
- Fresenius Medical Center (College Park, GA)
- **PURPOSE AND SCOPE:** The professional registered nurse Outpatient RN CAP 2 may be an entry level designation into the Clinical Advancement Program (CAP) for new ... modifications to treatment plan as indicated and notifies Team Leader, Charge Nurse , Supervisor or Physician as needed. + Assesses, collaborates, and documents… more
- Fresenius Medical Center (Smyrna, GA)
- **PURPOSE AND SCOPE:** The professional registered nurse Home Therapies RN CAP 2 may be an entry level designation into the Clinical Advancement Program (CAP) for ... guidance from the Educator, Preceptor or in collaboration with another Registered Nurse . + Performs ongoing, systematic collection and analysis of dialysis data for… more
- 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 appeals… more
- State of Georgia (Fulton County, GA)
- …experience in the analysis of medical services documentation and related claims 2) Utilization Review 3) Case Management 4) Analysis of CPT codes and/or ... 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)
- …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...of related work experience. **Skills:** + Prior Authorization + Utilization Reeview **Education:** + High School Diploma or equivalent… more
- Fresenius Medical Center (Sharpsburg, 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
- Marriott (Atlanta, GA)
- …workers' compensation losses. The NCM is responsible for conducting first level Utilization Review and coordinates subsequent levels if necessary, as required ... **Additional Information** Nurse CARE Manager **Job Number** 24111133 **Job Category**...that may include multiple states. + Conducts first level utilization review per jurisdictional requirements. + Coordinates… more
- Evolent Health (Atlanta, GA)
- …. Develop processes where indicated with direct oversight of centralized telephonic review process of all necessary utilization management components. + Partner ... knowledge of utilization management activities such as prior authorization, concurrent review , intake, appeals and grievances - **Required** + Five (5) to seven… more
- ChenMed (Decatur, GA)
- …care and cost effectiveness through the integrating and functions of case management, utilization review and discharge planning. The incumbent in this role ... (RN, LPN or other nursing discipline) required + A minimum of 7 years' utilization review /case management experience, including psychological aspects of care + A… more
- CenterWell (Decatur, 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...of Nursing. + Current state license as a Registered Nurse . + Proof of current CPR. + Valid driver's… more
- CenterWell (Atlanta, GA)
- …consulting with assigned nurse practitioners on management of complex patients. + Review all acute utilization events, with goal of reducing unnecessary ... operation, nights, and/or weekends.** This position will provide chart review for 3-5 hours per month. Additionally, this role...action. + Provide collaborating agreements for up to 4 nurse practitioners in the state of Georgia including but… more
- VIP Care (Atlanta, GA)
- …practicing interprofessional care delivery inclusive of Kroger pharmacists and dietitians. + Review and analyze TLC-determined claim and utilization data and ... week + Provide clinical supervision over four (4) Board Certified Family Nurse Practitioners Physician Roles and Responsibilities include, but are not limited to:… more
- HCA Healthcare (Savannah, GA)
- …management or critical care is preferred. + Certification in case management or utilization review is preferred. + InterQual experience is preferred. Memorial ... an organization that invests in you as a **Registered Nurse (RN) Case Manager** ? At **Memorial Health University...a difference. We are looking for a dedicated **Registered Nurse (RN) Case Manager** like you to be a… more
- HCA Healthcare (Savannah, GA)
- …Management or Critical Care is preferred. + Certification in Case Management or Utilization Review is preferred. + InterQual experience is preferred. Memorial ... passionate about delivering patient-centered care?** Submit your application for the **Registered Nurse (RN) Case Manager** position and spend more time at the… more
- HCA Healthcare (Savannah, GA)
- …Management or Critical Care is preferred + Certification in Case Management or Utilization Review is preferred + InterQual experience is preferred Memorial ... invested over 156,000 hours volunteering in our communities. As a **Registered Nurse (RN) Case Manager** with **Memorial Health University Medical Center** you can… more