- Elevance Health (Columbus, GA)
- …an expanding set of clinical domains, including radiology, cardiology and oncology. ** Nurse Reviewer I** **Location:** The selected candidates must reside in ... hours from 9:00 am-6:00 pm, rotating weekend shifts. The ** Nurse Reviewer I** is responsible for conducting...that are routine having limited or no previous medical review experience requiring guidance by more senior colleagues and/or… 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
- 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. To all current Molina employees: If you are interested in applying for this position, please apply through the… 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
- 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
- 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
- Molina Healthcare (Columbus, GA)
- …be supporting our Appeals and Grievances department. We are seeking a Registered Nurse with previous Appeals and Grievances experience and a clinical background. The ... and production levels are maintained + Performs monthly auditing of registered nurse and other clinical functions in Utilization Management (UM), Case Management… 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
- BioLife Plasma Services (Columbus, GA)
- …Center Manager and will perform as a Medical Support Specialist (Plasma Center Nurse ) to support plasma center operations. BioLife Plasma Services is a subsidiary of ... determine donor eligibility to donate plasma, management of donor adverse events, review of laboratory test results, and donor notification of unsuitable test… 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 ... E** **X** **PE** **R** **I** **E** **N** **C** **E:** + Peer Review , medical policy/procedure development, provider contracting experience. + Experience with NCQA,… more
- Crawford & Company (Columbus, GA)
- …individual. + May obtain records from the branch claims office. + May review files for claims adjusters and supervisors for appropriate referral for case management ... services. + May meet with employers to review active files. + Makes referrals for Peer reviews...the URAC-approved list of certifications (preferred); + A registered nurse (RN) license. + Must be compliant with state… 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