• RN Medical Claim Review Nurse Remote

    Molina Healthcare (GA)
    …experience including diagnosis. Candidates with knowledge of CPT/HCPCS codes, record review, chart audit , provider disputes, appeals, and 1500 & UB04 claim ... JOB DESCRIPTION **Job Summary** The Medical Claim Review Nurse provides support for medical claim review activities....clinical experience. * Facilitates document management, clinical reviews, bill audit findings and audit details in the… more
    Molina Healthcare (10/19/25)
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  • Primary Care Physician Lead

    CenterWell (Atlanta, GA)
    …+ Assisting in resolution of inquiries, requests, and complaints from patients + Ongoing chart review / audit of clinical staff to ensure quality care and ... intent Overseeing other clinicians which includes Physicians, Advanced Registered Nurse Practitioners (ARNP), and Physicians Assistants (PA) in: + Maintaining… more
    CenterWell (10/22/25)
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  • Advanced Registered Nurse Practitioner

    CoreCivic (Lumpkin, GA)
    …the highest quality care in an institutional setting. The Advanced Registered Nurse Practitioner under the supervision of the facility physician, provides advanced ... nursing services and patient care in the facility's medical...operational efficiency and cost effectiveness of health-related services. + Audit pharmacy use for adherence to formulary, as directed… more
    CoreCivic (10/09/25)
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  • Nurse Investigator

    State of Georgia (Fulton County, GA)
    Nurse Investigator Georgia - Fulton - Atlanta (https://ga.referrals.selectminds.com/jobs/64040/other-jobs-matching/location-only) Hot ... Office of the Attorney General Georgia Department of Law Nurse Investigator- Medicaid Fraud Division *To move forward in...of services, and appropriateness of services rendered based on chart review and client interview and assessment. + Maintains… more
    State of Georgia (09/18/25)
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  • AVP, Clinical Data Acquisition

    Molina Healthcare (Macon, GA)
    …functions. These functions include, but may not be limited to: chart retrieval strategy, risk adjustment retrieval performance, process effectiveness, market ... performance, project build, chart retrieval maximization and risk adjustment compliance. Molina Risk...people management experience * Minimum 5 years Risk adjustment audit /RADV experience * Demonstrated knowledge of and experience with… more
    Molina Healthcare (10/22/25)
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  • Director, Clinical Data Acquisition

    Molina Healthcare (GA)
    …Adjustment, is responsible for the implementation, monitoring, and oversight of all chart collection for Risk Adjustment, RADV, or Risk Adjustment-like projects, and ... other state specific audit projects and deliverables related to accurate billing and...training, onboarding for CDA team members, vendor management for chart collection vendors, Supplemental data, and chart … more
    Molina Healthcare (10/22/25)
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  • Diagnosis Related Group Clinical Validation…

    Elevance Health (Atlanta, GA)
    …make an impact:** + Analyzes and audits claims by integrating medical chart coding principles, clinical guidelines, and objectivity in the performance of medical ... audit activities. + Draws on advanced ICD-10 coding expertise,...recommendations. **Minimum Requirements:** + Requires current, active, unrestricted Registered Nurse license in applicable state(s). + Requires a minimum… more
    Elevance Health (10/22/25)
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