- Evolent (Atlanta, GA)
- …Evolent for the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior ... policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as... medical necessity and appropriateness of services using clinical review criteria. + Accurately documents all… more
- Molina Healthcare (Atlanta, GA)
- **Job Description** **Job Summary** The Medical Review Nurse provides support for medical claim and internal appeals review activities - ensuring ... Michigan RN license is required. **Job Duties** + Facilitates clinical / medical reviews of retrospective medical ...nursing experience, including at least 1 year of utilization review , medical claims review , long-term… 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 ... kidney disease. **Training and advancement:** You will enter our Clinical Leadership Program that creates and supports a culture...a tremendous asset that sets us apart. At Fresenius Medical Care, you will truly make a difference in… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …as appropriate. In collaboration with clinical leaders, provides weekly and daily clinical review of the surgical schedule to ensure procedures are posted ... limited to the entering and updating of scheduling data, monitoring, clinical verification, confirming and publishing the final procedural area schedules.… more
- Elevance Health (Atlanta, GA)
- …states; therefore, Multi-State Licensure will be required.** The ** Medical Management Nurse ** is responsible for review of the most complex or challenging ... ** Medical Management Nurse ** **Location: Virtual: This...management experience and requires a minimum of 2 years clinical , utilization review , or managed care experience;… more
- Emory Healthcare/Emory University (Decatur, GA)
- …be required based on department and specialty PL N: + Must meet all Clinical Nurse Employee Commitments. + Achieves electives/points and contact hours as defined ... 36 hours** Emory Healthcare is seeking a **Unit Charge Nurse , Medical Oncology** responsible for being a...theory, research and experience to respond to changes in clinical situations. This RN professional is able to apply… more
- ChenMed (Decatur, GA)
- …This position may require participation in risk and quality management programs, clinical meetings and other meetings. The Nurse Practitioner, Specialty ... nurse practitioner role. + Facilitate patient/family conferences to review treatment goals, optimize resource utilization, provide family education and identify… more
- Gentiva (Alpharetta, GA)
- …(LCD) criteria per hospice policy and regulatory requirements. + Communicate clinical findings, review treatment plans, lab results, diagnostics, and ... Partnerships. Transform Hospice Care.** We are seeking a dedicated Hospice Nurse Practitioner to perform Face-to-Face (F2F) encounters essential for hospice… more
- Humana (Atlanta, GA)
- …guidance where needed. Follows established guidelines/procedures. **KEY ACCOUNTABILITIES** + Review medical documentation, obtain additional information that may ... community and help us put health first** The Appeals Nurse 2 resolves clinical complaints and appeals....TRICARE, all HGB policies and procedures as well as medical necessity review criteria and privacy requirements… more
- Dialysis Clinic, Inc. (Fayetteville, GA)
- …experience; experience preferred **Benefits:** + Paid training with preceptor + Charge nurse continuing education classes + Comprehensive medical , dental and ... and document orders + Participate in patient care conferences, medical rounds and chart review ; document progress...as directed and supervised by the education coordinator, the clinical supervisor and/or the nurse manager +… more
- Fresenius Medical Center (Marietta, GA)
- …to the Inpatient Program Manager, appropriately credentialed physician, patient hospital primary nurse and others as indicated. + Delivers safe, effective care in a ... May be assigned to in-center patient care on an as needed basis + Review and comply with the Code of Business Conduct and all applicable company policies… more
- Humana (Atlanta, GA)
- …and help us put health first** The Nurse Auditor 2 performs clinical audit/validation processes to ensure that medical record documentation and diagnosis ... independent determination of the appropriate courses of action. The Nurse Auditor 2 validates and interprets medical ...coding experience to conduct a clinical validation review of the inpatient medical record to… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …to the excellence of our academic community. **Description** **Acute Care Nurse Practitioner Certificate Required** KEY RESPONSIBILITIES: + Assists in the evaluation ... + Documents the delivery of care in the individual's medical records. + Conducts patient interviews and documents patient...APP Wound Clinic + Perform Full Neuro Exam + Review Imaging (MRI/CT/XR) + Book Elective Cases + Consent… more
- PruittHealth (Union City, GA)
- …reviewing medical records and documentation. **KEY RESPONSIBILITIES:** 1. Coordinates clinical competency assessment and training needs of clinical staff, ... ** CLINICAL COMPETENCY COORDINATOR** **Join the PruittHealth family, where...conditions and acuity. 7. Meets regularly with DHS to review learning needs, coordinate training and to implement plans… more
- Sunrise Senior Living (Acworth, GA)
- …NAME** Varenita of West Cobb **Job ID** 2025-235063 **JOB OVERVIEW** The Wellness Nurse is responsible for monitoring the health and well-being of our residents and ... administration, communication with resident support services and families, and maintaining clinical quality assurance while leading and demonstrating the Mission for… more
- Cardinal Health (Atlanta, GA)
- …both scheduled outbound calls and inbound call queue. + Meets regularly with Clinical Supervisor and/or Senior Nurse , Individualized Care to discuss feedback ... who need them-faster.** **_What Individualized Care contributes to Cardinal Health_** Clinical Operations is responsible for providing clinical specialties… more
- BioLife Plasma Services (Douglasville, GA)
- …You will report to the Plasma Center Manager and will perform as a Medical Support Specialist (Plasma Center Nurse ) to support plasma center operations. BioLife ... of laboratory test results, and donor notification of unsuitable test results. The Medical Support Specialist (Plasma Center Nurse ) works under the guidance of… more
- BioLife Plasma Services (Duluth, GA)
- …You will report to the Plasma Center Manager and will perform as a Medical Support Specialist (Plasma Center Nurse ) to support plasma center operations. _BioLife ... results, and donor notification of unsuitable test results. The Medical Support Specialist (Plasma Center Nurse ) works...Medical Support Specialist + Two years in a clinical or hospital setting **What Takeda can offer you:**… more
- Vatica Health (Atlanta, GA)
- …is seeking clinically experienced and detailed-oriented nurses to join our team. As a Nurse Consultant, you will collect, review and analyze patient data to ... improve care coordination, quality metrics, and medical cost savings. The ideal candidate has a track...+ Minimum of 3 years of recent adult health clinical experience as a Registered Nurse (RN)-… more
- Elevance Health (Atlanta, GA)
- … necessity. + Extrapolates and summarizes medical information for medical director, consultants and other external review . + Prepares recommendations ... ** Nurse Appeals** **Hybrid 1:** This role requires associates... Appeals** is responsible for investigating and processing and medical necessity appeals requests from members and providers. **How… more