- Elevance Health (Columbus, GA)
- …Works on reviews that are routine having limited or no previous medical review experience requiring guidance by more senior colleagues and/or management. + Partners ... information presented meets medical necessity criteria or requires additional medical necessity review . + Conducts initial medical necessity review of exception… more
- Molina Healthcare (Columbus, GA)
- …DESCRIPTION** **Job Summary** Utilizing clinical knowledge and experience, responsible for review of documentation to ensure medical necessity and appropriate level ... quality of care issues. + Assists with Complex Claim review including DRG Validation, Itemized Bill Review ,...Claim review including DRG Validation, Itemized Bill Review , Appropriate Level of Care, Inpatient Readmission, and any… more
- Veterans Affairs, Veterans Health Administration (Tuskegee, AL)
- …Demonstrates proficiency in collecting patient data by interview, examination and review of records systematically; completes nursing assessment within the required ... assigned. VA offers a comprehensive total rewards package: VA Nurse Total Rewards Pay: Competitive salary, regular salary increases,...final tour of duty will be determined by the Nurse Manager based on the unit needs. Subject to… more
- BrightSpring Health Services (Columbus, GA)
- …dedicated team + Drive and deliver profitable growth Essential Job Responsibilities + Review daily appointment needs: packets completed and available to staff + ... Review daily nursing calendar, schedule, attend if possible. Ensure...accredited school of nursing OR License as a Registered Nurse , current and in good standing + Valid driver's… more
- State of Georgia (Muscogee County, GA)
- Licensed Practical Nurse (LPN) - (Behavioral Health) - 1st Shift (Community Integrated Home) Georgia - Muscogee - Columbus ... currently seeking candidates for the position(s) of Licensed Practical Nurse 3 at a Community Home located in Columbus,...in new, unusual or emergency situations; and receive periodic review of work to ensure that acceptable practices are… more
- Elevance Health (Columbus, GA)
- **Diagnosis Related Group Clinical Validation Auditor-** **Registered Nurse ** **Location:** This position will work a hybrid model (remote and office). Ideal ... documentation supports the conditions and DRGs billed and reimbursed. Specializes in review of Diagnosis Related Group (DRG) paid claims. **How you will make… more
- Fresenius Medical Center (Lagrange, GA)
- …therapy for assigned patients under the direct supervision of a registered nurse . Participates in the implementation and evaluation of patient care. Responsible for ... intravenous medication in accordance with physician orders and state nurse practice laws. + Perform and document pre, interim,...+ Perform and document pre, interim, and post treatment review of patient condition. + Initiate basic CPR measures… more
- Molina Healthcare (Columbus, GA)
- …meetings. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse (RN). **Required Experience** 1-3 years of hospital or medical ... clinic experience. **Required License, Certification, Association** Active, unrestricted State Registered Nursing (RN) license in good standing. **Preferred Experience** Previous experience in hospital Acute care, ER or ICU Previous experience with InterQual… more
- Elevance Health (Columbus, GA)
- …precertification, prior authorization, and post service requests. + Refers cases requiring clinical review to a Nurse reviewer . + Responsible for the ... I** will be responsible for coordinating cases for precertification and prior authorization review . **How you will make an impact:** + Managing incoming calls or… more
- Elevance Health (Columbus, GA)
- …Finder and follows up with provider on referrals given. + Refers cases requiring clinical review to a nurse reviewer ; and handles referrals for specialty ... care. + Processes incoming requests, collection of information needed for review from providers, utilizing scripts to screen basic and complex requests for… more
- Fresenius Medical Center (Auburn, AL)
- …dialysis therapy for patients under the direct supervision of a licensed nurse in accordance with organization policies, procedures, and training and in compliance ... significant information and/or change in patient condition directly to the registered nurse or supervisor. + Observe patient and conduct machine safety checks… more
- Fresenius Medical Center (Valley, AL)
- …dialysis therapy for patients under the direct supervision of a licensed nurse in accordance with organization policies, procedures, and training and in compliance ... significant information and/or change in patient condition directly to the registered nurse or supervisor. + Observe patient and conduct machine safety checks… more
- Molina Healthcare (Columbus, GA)
- …and medical records to document relevant findings of a post pay clinical review . This position manages documents and prioritizes case load to ensure timely turn ... guidelines, internal policies, and contract requirements. This position completes a medical review to facilitate a referral to law enforcement or for payment… more
- Molina Healthcare (Columbus, GA)
- …the Chief Medical Officer. + Evaluates authorization requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the ... Public Health, Healthcare Administration, etc. **PREFERRED EXPERIENCE:** + Peer Review , medical policy/procedure development, provider contracting experience. + Experience… more
- Veterans Affairs, Veterans Health Administration (Tuskegee, AL)
- …determined by the VHA Education Loan Repayment Services program office after review of the EDRP application. Former EDRP participants ineligible to apply. ... GPC clinics. Directs and supervises clinical activities of the GPC physicians and nurse practitioner. Devotes 80% of time to direct patient care, serves as a… more
- Molina Healthcare (Columbus, GA)
- …and results across Molina Health Plans & Segments. **KNOWLEDGE/SKILLS/ABILITIES** + Review existing case management standards and processes and establishes new ... standards and processes to drive clinical excellence and quality results across the enterprise. + Identifies case management best practices and capabilities across all plans and Lines of Business while supporting standardization. + Responsible for monitoring… more
- Fresenius Medical Center (Tallassee, AL)
- …and the patient's family/support persons. + In collaboration with the physician and nurse , participates in the discussion of patient DNR status in the facility to ... for all patients based on acuity level. + Participates in monthly Quality review meetings with the interdisciplinary team. Reports on quality indicators related to… more