- 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
- Humana (Atlanta, GA)
- …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 ... and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are varied and… 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 preferred ... We are excited to bring on a highly motivated Nurse Disability Consultant to our clinical organization. This position...in a career at Lincoln, we encourage you to review our current openings and apply on our website.… 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
- Centene Corporation (Atlanta, GA)
- …to performance, compliance, quality, and efficiency standards + Collaborates with utilization management team to resolve complex care member issues + Maintains ... knowledge of regulations, accreditation standards, and industry best practices related to utilization management + Works with utilization management team and… more
- 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
- Humana (Atlanta, GA)
- …reports in Access and/or SQL + Graduate degree + Utilization Management Review Experience + Registered Nurse (RN) Credentials + Home Health, Durable Medical ... Equipment, and/or Skilled Nursing Facility Experience **Additional Information** **Scheduled Weekly Hours** 40 **Pay Range** The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the… 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 ... well as customer service programs. Functions or Scope of Assigned Duties: The Nurse Employee Occupational Health (EOH) Registered Nurse (RN) is responsible for… 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
- 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
- Elevance Health (Atlanta, GA)
- **Telephonic Nurse Case Manager II** **Location: This is a virtual position. Candidates must reside within 50 miles of an Elevance Health Pulse Point location.** ... in different states; therefore, Multi-State Licensure will be required.** The **Telephonic Nurse Case Manager II** is responsible for care management within the… more
- Elevance Health (Atlanta, GA)
- **Telephonic Nurse Case Manager II** **Location: This is a virtual position. Candidates must reside within 50 miles of an Elevance Health Pulse Point location.** ... in different states; therefore, Multi-State Licensure will be required.** The **Telephonic Nurse Case Manager II** is responsible for care management within the… more
- Fresenius Medical Center (Lawrenceville, GA)
- …all FMS manuals. + Accountable for completion of the Annual Standing Order Review and ICD coding. + Checks correspondence whether electronic, paper or voice mail, ... supporting billing and collection activities. + Responsible for efficient utilization of medication, laboratory, inventory, supplies and equipment to achieve… more
- Elevance Health (Atlanta, GA)
- …payment. May also manage appeals for services denied ,** **continued stay review , care coordination, and discharge planning for appropriateness of treatment setting ... but are not limited to:** + Conducts precertification, continued stay review , care coordination, or discharge planning for appropriateness of treatment setting… 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
