- GHR Healthcare (Atlanta, GA)
- …Pay Rate: 37.50 -40.00 Hourly (paid weekly) What You'll Do: Clinical Analysis: Review medical records to determine the necessity of patient services based on ... advanced criteria. Provider Interaction: Collaborate with healthcare providers to clarify and obtain additional clinical information. Decision-Making: Authorize medically necessary services and refer cases that don't meet criteria to the Medical Director.… more
- Novo Nordisk Inc. (Atlanta, GA)
- …relationships include key opinion leaders (KOL's), academic institutions, physicians, nurse practitioners, advocacy group leaders, pharmacists, blood bank staff, ... providers and IHNs; c) develops appropriate use of NNI products and greater utilization of its services d) supports and assists representatives and managers in… more
- Pacer Staffing (Atlanta, GA)
- …criteriarequired Preferred: . TRICARE experience . Qualified for Certified Professional Utilization Review Certification or Certified Professional Utilization ... Job Summary This individual contributor position reports to the Directors of Utilization Management (UM) and Referral Management (RM) and supports both RM and… more
- Pacer Staffing (Atlanta, GA)
- …criteria required. Preferred: TRICARE experience Qualified for Certified Professional Utilization Review Certification or Certified Professional Utilization ... Description: Summary: This individual contributor position reports to the Directors of Utilization Management (UM) and Referral Management (RM) and supports both RM… more
- Pacer Staffing (Atlanta, GA)
- …Provides Disease Management (DM) services to TRICARE beneficiaries. . The DM nurse will collaboratively assess, plan, implement, coordinate, monitor and evaluate the ... the beneficiary to successfully manage their chronic condition. . The DM nurse will partner with the interdisciplinary care team to identify appropriate care… more
- Pacer Staffing (Atlanta, GA)
- …services as clinically appropriate and according to TRICARE policy. Conducts clinical review for requested services particular to the ECHO according to policy, ... high-profile or sensitive issues to the Medical Director for review . Functions as an advocate for the beneficiary by...States, as a Licensed Clinical Social Worker or Registered Nurse US Citizenship Must be able to receive a… 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
- 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 (Stockbridge, 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
- Fresenius Medical Center (Decatur, GA)
- …state regulations, and accrediting agency standards where applicable. + Participate in review business and finances of the site, including financial reports, market ... the security and integrity of facility + Responsible for efficient utilization of medication, laboratory, inventory, supplies and equipment to achieve supply… more
- Fresenius Medical Center (Loganville, GA)
- …dialysis clinic. You will collaborate with the Medical Director and the Charge Nurse regarding the provision of quality patient care in the dialysis clinic. ... data collections and auditing activities. + Manages clinic financials including efficient utilization of supplies or equipment and regular profits and loss review… more
