• Utilization Review Registered…

    Emory Healthcare/Emory University (Atlanta, GA)
    …_development,_ and leadership programs + And more **Description** The ** Utilization Review (UR) Specialist** is a Registered Nurse responsible for conducting ... when necessary, discussions with the provider team and/or Medical Director of UR. + Conducts thorough medical necessity reviews...experience or a minimum of two years of previous utilization review experience. + Must have a… more
    Emory Healthcare/Emory University (08/30/25)
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  • Utilization Management Nurse…

    CVS Health (Atlanta, GA)
    …(RN) - active license. + 3+ Years of clinical experience. + 1+ Year of Utilization Review Management and/or Medical Management experience. + Must have active and ... a collaborative process to implement, coordinate, monitor and evaluate medical review cases. + Applies the appropriate clinical criteria/guideline and plan language… more
    CVS Health (08/31/25)
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  • Medical Director (Marketplace)

    Molina Healthcare (Savannah, GA)
    …the Chief Medical Officer. + Evaluates authorization requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the ... and interacts with network and group providers and medical managers regarding utilization practices, guideline usage, pharmacy utilization and effective resource… more
    Molina Healthcare (08/28/25)
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  • Licensed Practical Nurse /Licensed…

    STG International (Milledgeville, GA)
    …+ Assist the Director of Nursing in planning clinical supervision for nurse aide trainees, nursing students and newly hired nurses. + Assist in training ... STGi is seeking a Licensed Practical Nurse /Licensed Vocational Nurse to provide services...reports, evaluations, studies, charting, etc., as necessary. + Periodically review the department's policies and procedures manuals, job descriptions,… more
    STG International (07/30/25)
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  • Sr VP Medical Director (Hourly)

    Sedgwick (Atlanta, GA)
    …(10) of related experience required to include one (1) to three (3) years utilization review experience and three (3) years clinical quality control. **Skills & ... Workplaces in Financial Services & Insurance Sr VP Medical Director (Hourly) The ideal candidate would work 8-20 hours...+ Knowledge of ADAA and FMLA + Knowledge of utilization review procedures + Knowledge of clinical… more
    Sedgwick (08/22/25)
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  • Med Mgmt Nurse (US)

    Elevance Health (Atlanta, GA)
    …or case management experience and requires a minimum of 2 years clinical, utilization review , or managed care experience; or any combination of education ... **Medical Management Nurse ** **Location:** This role enables associates to work...is medically necessary and provides consultation to the Medical Director on cases that are unclear or do not… more
    Elevance Health (08/29/25)
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  • Nurse Investigator

    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://ga.referrals.selectminds.com/jobs/64040/other-jobs-matching/location-only) Hot… more
    State of Georgia (06/19/25)
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  • Dialysis Clinical Manager Registered Nurse…

    Fresenius Medical Center (Loganville, GA)
    …Clinical Manager, you may advance your career into an Area Team Lead or Director of Operations role. **Our culture:** We believe our employees are our most important ... auditing activities. + Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. + Manages clinic… more
    Fresenius Medical Center (08/01/25)
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  • RN Clinical Manager, Home Health

    CenterWell (Griffin, GA)
    …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and ... delivery, and documentation requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking for performance … more
    CenterWell (08/23/25)
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  • Healthcare Operations Facility Administrator

    Fresenius Medical Center (Newnan, GA)
    …the daily operations of the dialysis clinic. You will collaborate with the Medical Director and the Charge Nurse regarding the provision of quality patient care ... leadership. As a Facility Administrator, you may advance your career into a Director of Operations then senior leadership role. **Our culture:** We believe our… more
    Fresenius Medical Center (08/28/25)
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