- Humana (Atlanta, GA)
- …of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, ... determination of the appropriate courses of action. The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and independent… more
- Waystar (Atlanta, GA)
- **ABOUT THIS POSITION** The Clinical Product Consultant for Utilization Management is a member of the Customer Success Organization who will provide ... best practice workflows. We are specifically seeking an experienced Utilization Review Nurse who will serve as...acute care setting + 2+ years of experience in utilization management + Knowledge and understanding of… more
- Elevance Health (Atlanta, GA)
- **Title: Utilization Management Representative I** **Virtual:** This role enables associates to work virtually full-time, with the exception of required ... an accommodation is granted as required by law._ The ** Utilization Management Representative I** will be responsible...authorization, and post service requests. + Refers cases requiring clinical review to a Nurse reviewer. +… more
- Molina Healthcare (Atlanta, GA)
- …hearing officer during fair hearings as may be required. * Serves as a clinical resource for utilization management , chief medical officer, physicians, and ... JOB DESCRIPTION **Job Summary** The RN Clinical Appeals Nurse provides support for...officer on denial decisions. * Resolves escalated complaints regarding utilization management and long-term services and supports… more
- Evolent (Atlanta, GA)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. ... physician-developed medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care… more
- Fresenius Medical Center (Atlanta, GA)
- **About this role:** As a Clinical Manager with Fresenius Medical Care, you will ensure that quality patient care is delivered while maintaining clinical ... or chronic kidney disease. **Training and advancement:** You will enter our Clinical Leadership Program that creates and supports a culture of continuous learning… more
- Elevance Health (Atlanta, GA)
- …minimum of 4 years managed care experience and requires a minimum of 2 years clinical , utilization review, or case management experience; or any combination ... **Medical Management Nurse ** **Hours: 8am-5pm EST** **Location**...in multiple states. **Preferred Skills, Capabilities & Experiences:** + Utilization management experience. + Strong of computer… more
- ChenMed (Decatur, GA)
- …position may require participation in risk and quality management programs, clinical meetings and other meetings. The Nurse Practitioner, Specialty incumbent ... of practice + A minimum of 3 years experience working in Cardiology as a Nurse Practitioner in an out-patient clinical setting + Basic Life Support (BLS)… more
- CVS Health (Atlanta, GA)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... self-insured clients. + Application and/or interpretation of applicable criteria and clinical guidelines, standardized care management plans, polices, procedures… more
- Elevance Health (Atlanta, GA)
- …solving with providers, claims or service issues. + Assists with development of utilization /care management policies and procedures. + Within the medical ... **Transplant Nurse II** **Location:** Virtual: This role enables associates...II** will be responsible for providing case and/or medical management for members receiving transplant services. Continue to learn… more
- Evolent (Atlanta, GA)
- …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and ... accomplishments. **What You Will Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to company… more
- Elevance Health (Atlanta, GA)
- …criteria._** 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 role enables...claims or service issues. + Assists with development of utilization /care management policies and procedures. **Minimum requirements:**… more
- Humana (Atlanta, GA)
- …or comparable (such as Interqual, etc.) **Preferred Qualifications** + Utilization Review/Quality Management experience + BA/BSN degree **Work-At-Home ... of our caring community and help us put health first** The Pre-Authorization Nurse 2 reviews prior authorization requests for appropriate care and setting, following… more
- Elevance Health (Atlanta, GA)
- …criteria._** 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 role enables...claims or service issues. + Assists with development of utilization /care management policies and procedures. **Minimum Requirements:**… more
- Elevance Health (Atlanta, GA)
- …to 8:00 PM EST. The ** Nurse Case Manager II** is responsible for care management within the scope of licensure for members with complex and chronic care needs by ... ** Nurse Case Manager II** **Location:** This role enables...providers, claims or service issues. Assists with development of utilization /care management policies and procedures. **Minimum Requirements:**… more
- Elevance Health (Atlanta, GA)
- …with providers, claims or service issues. + Assists with development of utilization /care management policies and procedures, chairs and schedules meetings, as ... **Telephonic Nurse Case Manager Senior** **Sign on Bonus: $2000.**... Case Manager Senior** . is responsible for care management within the scope of licensure for members with… more
- Elevance Health (Atlanta, GA)
- …with providers, claims or service issues. + Assists with development of utilization /care management policies and procedures. **Minimum Requirements:** + Requires ... **Telephonic Nurse Case Manager I** **Location: This role enables... Case Manager I** is responsible for telephonic care management within the scope of licensure for members with… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …more **Description** **11am-11:30pm** We're seeking an **Transfer Center Registered Nurse is** responsible for accepting incoming referral information via multimedia ... and working directly with bed management and direct care nursing to coordinate inpatient bed...Coordinates, prioritizes, and optimizes patient flow using knowledge of clinical and operational activities throughout the hospital network. +… more
- CenterWell (Decatur, GA)
- …This branch is referred to as our CWHH Decatur, GA branch.** The **RN Clinical Manager** coordinates and oversees all direct care patient services provided by ... clinical personnel. This role is a focused on both... documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates… more
- CenterWell (Atlanta, GA)
- …with scheduled hours starting Friday evening through Monday morning to support clinical operations across multiple home health branch locations.** The **RN Weekend ... Clinical Manager** provides weekend oversight and clinical ... documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates… more