- Cognizant (Atlanta, GA)
- …background - Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management experience with managed health care plan . 3 years' experience ... Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced...care revenue cycle or clinic operations . Experience in utilization management to include Clinical Appeals and… more
- CenterWell (Atlanta, GA)
- …RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability ... Therapy, DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare… more
- 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 ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...in an acute care setting + Previous experience in utilization management / utilization review … more
- Evolent (Atlanta, GA)
- …responsible for support and assistance for all cardiology administrative and clinical utilization management and quality improvement functions under the auspices ... with the Director of UM to ensure client satisfaction. Perform all peer clinical review activities while located in a state or territory of the United States. Acts… more
- Actalent (Atlanta, GA)
- Utilization Review (Registered Nurse ) Job...GA or Compact. + 1+ years of experience in Utilization Management (UM). + 1+ years of experience ... Service, Claims, Contracts and Benefits - Appeals, and Risk Management . Essential Skills + Registered Nurse (RN)...+ Experience with MCG or Interqual is preferred. + Utilization review experience is a plus. Job… more
- Elevance Health (Atlanta, GA)
- …precertification, prior authorization, and post service requests. + Refers cases requiring clinical review to a Nurse reviewer . + Responsible for the ... ** Utilization Management Representative I** **Virtual:** This...responsible for coordinating cases for precertification and prior authorization review . **How you will make an impact:** + Managing… more
- Waystar (Atlanta, GA)
- …end user adoption of best practice workflows. We are specifically seeking an experienced Utilization Review Nurse who will serve as an integral contributor ... **ABOUT THIS POSITION** The Clinical Product Consultant for Utilization Management is a member of the Customer Success Organization who will provide clinical… more
- STG International (Milledgeville, GA)
- …FUNCTIONS: + Ensure the facility meets the minimum staffing levels for nurses and nurse aides; complete required posting of nursing staff data as required. + Ensure ... forms, reports, evaluations, studies, charting, etc., as necessary. + Periodically review the department's policies and procedures manuals, job descriptions, etc.,… more
- Battelle Memorial Institute (Fort Benning, GA)
- …within legal and professional parameters + Knowledge and skill in using pre-established utilization review criteria to recognize and report actual or potential ... by a recognized certifying organization, ie, Commission for Case Management Certification or American Nurse Credentialing Center...programs for equal treatment of all staff and full utilization of all qualified employees at all levels within… more
- Molina Healthcare (Savannah, GA)
- …chief medical officer on denial decisions. * Resolves escalated complaints regarding utilization management and long-term services and supports (LTSS) issues. * ... be required. * Serves as a clinical resource for utilization management , chief medical officer, physicians, and...the specific programs supported by the plan such as utilization review , medical claims review ,… more