- Humana (Atlanta, GA)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... independent determination of the appropriate courses of action. The Utilization Management Nurse 2 uses clinical...skills to make an impact** **Required Qualifications** + **Licensed Registered Nurse (RN)** in the (appropriate state)… 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
- CVS Health (Atlanta, GA)
- …+ Perform medical necessity reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse with at least 1 year of experience in a hospital ... is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that...setting. + A Registered Nurse that holds an active, unrestricted… more
- Molina Healthcare (Atlanta, GA)
- …health, pharmacy, etc.), or equivalent combination of relevant education and experience. * Registered Nurse (RN). License must be active and unrestricted in ... JOB DESCRIPTION **Job Summary** The RN Clinical Appeals Nurse provides support for...hearings as may be required. * Serves as a clinical resource for utilization management, chief medical… more
- ChenMed (Decatur, GA)
- …We're rapidly expanding and we need great people to join our team. The Registered Nurse , Care Line, is responsible for providing telephonic triage directional ... on-call coverage, the incumbent in this role provides remote clinical advice and assessments within license and as possible...license and as possible given technology and medium. The registered nurse collaborates with primary caregivers and… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …+ And more **Description** **11am-11:30pm** We're seeking an **Transfer Center Registered Nurse is** responsible for accepting incoming referral information ... indvidual: + Coordinates, prioritizes, and optimizes patient flow using knowledge of clinical and operational activities throughout the hospital network. + Collects … more
- Evolent (Atlanta, GA)
- …+ Performs other duties as assigned. **The Experience You'll Need (Required):** + Registered Nurse or Licensed Practical/Vocational Nurse with a current, ... for the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals.… more
- CenterWell (Decatur, GA)
- …Science in Nursing (BSN) strongly preferred. **License/Certifications:** + Active and unrestricted Registered Nurse (RN) license or Compact State RN license with ... to as our CWHH Decatur, GA branch.** The **RN Clinical Manager** coordinates and oversees all direct care patient...A minimum of 2 years of experience as a Registered Nurse (RN). + Home health experience… more
- CenterWell (Atlanta, GA)
- …Science in Nursing (BSN) strongly preferred. **License/Certifications:** + Active and unrestricted Registered Nurse (RN) license or Compact State RN license with ... hours starting Friday evening through Monday morning to support clinical operations across multiple home health branch locations.** The...A minimum of 2 years of experience as a Registered Nurse (RN). + Home health experience… more
- CVS Health (Atlanta, GA)
- …empowered to: + Deliver forward-thinking clinical insights derived from analyzing clinical utilization patterns and member behavior impact on medical costs. ... internal partners and customers. **Required Qualifications** + Active, unrestricted registered nurse (RN) license + Minimum 5...nurse (RN) license + Minimum 5 years of clinical experience + At least 3 years in acute… more
- Molina Healthcare (Atlanta, GA)
- …authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse (RN). License must be active and unrestricted in ... JOB DESCRIPTION Job Summary Provides support for clinical member services review assessment processes. Responsible for...to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications *… more
- CenterWell (Morrow, GA)
- …to the strategic intent Overseeing other clinicians which includes Physicians, Advanced Registered Nurse Practitioners (ARNP), and Physicians Assistants (PA) in: ... early detection. The PL is responsible for executing the clinical strategy through the management of their own patient...+ Identifying trends and areas of opportunity in pharmacy utilization (pharmacy management) to impact Part D per Member… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …Unit or PGP practice area, the **Director of Patient Care Services ( Registered Nurse / RN)** will lead and manage clinical operations and initiatives to ... vision. + Develop programs to enhance value-based services and regulatory compliance. ** Clinical & Operational Oversight:** + Oversee clinical and operational… more
- Molina Healthcare (Atlanta, GA)
- For this position we are seeking a (RN) Registered Nurse who must hold a compact license. This is a Remote position, home office with internet connectivity of ... authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse (RN). License must be active and unrestricted in… more
- PruittHealth (Atlanta, GA)
- …with long-term care population **MINIMUM LICENSURE/CERTIFICATION REQUIRED BY LAW:** * Licensed Registered Nurse with current, unrestricted license in state of ... **JOB PURPOSE:** Responsible for the oversight of clinical care management of community based long-term care...in a managed care setting focused on experience in utilization review/case management and at least two years case… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …practice area, the Director, Patient Care Service will lead and manage clinical operations and initiatives to achieve productivity, quality, safety, and satisfaction ... + 4. Develop programs to enhance value-based services and regulatory compliance. + Clinical & Operational Oversight: + 1. Oversee clinical and operational… more
- Highmark Health (Atlanta, GA)
- …years of experience in Managed Care **LICENSES or CERTIFICATIONS** **Required** + Registered Nurse **Preferred** + Certified Medical Coder or related **SKILLS** ... itemized bills, and claims data to assure appropriate level of payment and resource utilization . It is also used to identify issues which can be used for education… more