- CVS Health (Atlanta, GA)
- …with heart, each and every day. **Position Summary** As a Care Management Associate you will be supporting comprehensive coordination of medical services including ... and supporting the implementation of care plans to promote effective utilization of health services service. Promotes/supports quality effectiveness of Healthcare… more
- Elevance Health (Atlanta, GA)
- …members and providers. **How you will make an impact:** + Perform physician-level case review , following initial nurse review , of Medical Oncology regimens ... and supportive care. + Perform physician-level case review , following initial nurse review ,...maintain knowledge of relevant policies and regulations pertaining to utilization review of oncology care. + Participate… more
- CenterWell (Marietta, GA)
- …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and ... requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking...and reliable transportation. + Two years as a Registered Nurse with at least one-year of management … more
- CenterWell (Atlanta, GA)
- …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and ... the utilization of Performance Improvement principles. + Responsible for review of the appropriate number of Case Managers and clinical staff documentation… more
- Datavant (Atlanta, GA)
- …healthcare. The purpose of the Denial Prevention Specialist is to effectively defend utilization of available health services, review of admissions for medical ... letter Identification of referrals to the medical director for review + Select appropriate preferred and contracted providers +...management Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well versed in… more
- Highmark Health (Atlanta, GA)
- …and education or if necessary involve Special Investigation Unit or the Utilization Management area. **ESSENTIAL RESPONSIBILITIES** + Implement the pre-payment ... and the proper action to complete the retrospective claim review with the goal of proper and timely payment...data to assure appropriate level of payment and resource utilization . It is also used to identify issues which… more
- HCA Healthcare (Savannah, GA)
- …of experience in hospital case management is required. + Certification in case management or utilization review is preferred. + InterQual experience is ... an organization that invests in you as a Registered Nurse (RN) Case Manager? At Memorial Health University Medical...stay, managing the length of stay, ensuring appropriate resource management , while developing a safe appropriate discharge plan. +… more
- HCA Healthcare (Augusta, GA)
- …Case Management is required for this PRN role. + Certification in Case Management or Utilization Review is preferred. + InterQual experience is ... you have the PRN career opportunities as a **Registered Nurse (RN) Case Manager** you want with your current...stay, managing the length of stay, ensuring appropriate resource management , while developing a safe appropriate discharge plan. +… more
- CenterLight Health System (Bostwick, GA)
- …experience in care/case management , disease management , population health management , utilization review , quality assurance, or discharge planning ... clinical onboarding and reassessment, UAS-NY completion, comprehensive assessment, medication review , and post-hospital discharge evaluation. The Clinical Assessment Manager… more
- CenterWell (Atlanta, GA)
- …opportunities for education/coaching + Identifying trends and areas of opportunity in pharmacy utilization (pharmacy management ) to impact Part D per Member per ... early detection. The PL is responsible for executing the clinical strategy through the management of their own patient panel as well as those of the clinicians whom… more