- Humana (Atlanta, GA)
- …a team **Preferred Qualifications** + Bachelor's degree + Previous experience in prior authorization , claims, and/or utilization management in healthcare, ... a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination,… more
- CVS Health (Atlanta, GA)
- …1 year of Utilization Management experience in concurrent review or prior authorization . + Strong decision-making skills and clinical judgment in independent ... high-quality healthcare for members. We are seeking a dedicated Utilization Management (UM) Nurse Consultant to join...+ Experience in a high-volume clinical call center or prior remote work environment. **Education** + Associate's degree in… more
- Centene Corporation (Atlanta, GA)
- …between utilization management team, members, and providers + Monitors prior authorization , concurrent review, and/or retrospective clinical review nurses ... a fresh perspective on workplace flexibility. **Position Purpose:** Supervises Prior Authorization , Concurrent Review, and/or Retrospective Review Clinical… more
- Elevance Health (Atlanta, GA)
- …Management Representative I** will be responsible for coordinating cases for precertification and prior authorization review. **How you will make an impact:** + ... ** Utilization Management Representative I** **Virtual:** This role enables...provides authorization for inpatient admission, outpatient precertification, prior authorization , and post service requests. +… more
- Centene Corporation (Atlanta, GA)
- …(BH) and/or autism spectrum disorder needs and clinical standards + Performs prior authorization reviews related to BH to determine medical appropriateness ... Analyzes BH member data to improve quality and appropriate utilization of services + Interacts with BH healthcare providers...Health Professional (LMHP) required or + RN - Registered Nurse - State Licensure and/or Compact State Licensure required… more
- Centene Corporation (Atlanta, GA)
- …services to ensure level of care and services are medically appropriate + Performs prior authorization reviews related to mental health and substance abuse to ... Analyzes BH member data to improve quality and appropriate utilization of services + Provides education to providers members...Health Professional (LMHP) required or + RN - Registered Nurse - State Licensure and/or Compact State Licensure required… more
- Molina Healthcare (GA)
- …benefits and eligibility for requested treatments and/or procedures. + Conducts prior authorization reviews to determine financial responsibility for Molina ... + Processes requests within required timelines. + Refers appropriate prior authorization requests to Medical Directors. +...Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization… more
- US Tech Solutions (GA)
- …leadership team. **Experience:** + 1-3 years of related work experience. **Skills:** + Prior Authorization + Utilization Reeview **Education:** + High School ... from distractions. You will provide processing and communication of specialty medication prior authorization (PA) requests reviewed by the Specialty Medical … more
- Veterans Affairs, Veterans Health Administration (Atlanta, GA)
- …a bachelor's level degree in Nursing may have opportunity to become registered as a nurse with a state licensing board prior to completion of the bridge program. ... maternal and fetal outcomes. Retrieves statistical data on maternity care and utilization at the local VAMC, using Veterans Health Administration (VHA) databases.… more
- Molina Healthcare (Atlanta, GA)
- …benefits and eligibility for requested treatments and/or procedures. + Conducts prior authorization reviews to determine financial responsibility for Molina ... + Processes requests within required timelines. + Refers appropriate prior authorization requests to Medical Directors. +...Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization… more