• Case Manager, Registered Nurse…

    CVS Health (Atlanta, GA)
    …+ Perform medical necessity reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse with at least 1 year of experience in a hospital ... setting. + A Registered Nurse that holds an active, unrestricted...lower levels of care. + 1+ years' experience in Utilization Review . + CCM and/or other URAC… more
    CVS Health (08/15/25)
    - Related Jobs

  • SNF Utilization Management RN…

    Humana (Atlanta, GA)
    …an impact** **Use your skills to make an impact** **Required Qualifications** + **​Licensed Registered Nurse ( RN )** in the (appropriate state) with no ... caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing...in an acute care setting + Previous experience in utilization management/ utilization review for a… more
    Humana (09/12/25)
    - Related Jobs

  • RN , Manager, Utilization Management…

    Humana (Atlanta, GA)
    …areas. **Use your skills to make an impact** **Required Qualifications** + An active, unrestricted Registered Nurse ( RN ) license in the state of Michigan. + ... Previous experience in utilization management and/or utilization review ....business administration. **Additional Information** + **Workstyle:** This is a remote position. + **Travel:** Up to 25% travel may… more
    Humana (09/28/25)
    - Related Jobs

  • Manager, Healthcare Services; Utilization…

    Molina Healthcare (GA)
    …and experience. * At least 1 year of health care management/leadership experience. * Registered Nurse ( RN ), Licensed Vocational Nurse (LVN), Licensed ... skills. * Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications * Registered Nurse ( RN ). License must be active and… more
    Molina Healthcare (09/19/25)
    - Related Jobs

  • Director, Healthcare Services; Utilization…

    Molina Healthcare (GA)
    …education and experience. * At least 3 years health care management/leadership required. * Registered Nurse ( RN ), Licensed Vocational Nurse (LVN), ... This position will offer remote work flexibility, however, the selected candidate must...Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications * Registered Nurse ( RN ). License must… more
    Molina Healthcare (09/19/25)
    - Related Jobs

  • Utilization Review Clinician…

    Centene Corporation (Atlanta, GA)
    …Family Therapist (LMFT) required or + Licensed Mental Health Professional (LMHP) required or + RN - Registered Nurse - State Licensure and/or Compact State ... abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with...plus holidays, and a flexible approach to work with remote , hybrid, field or office work schedules. Actual pay… more
    Centene Corporation (08/10/25)
    - Related Jobs

  • Utilization Review Clinician - ABA

    Centene Corporation (Atlanta, GA)
    …Family Therapist (LMFT) required or + Licensed Mental Health Professional (LMHP) required or + RN - Registered Nurse - State Licensure and/or Compact State ... Treatment Plans required. Knowledge of ABA services and BH utilization review process required. Experience working with...plus holidays, and a flexible approach to work with remote , hybrid, field or office work schedules. Actual pay… more
    Centene Corporation (08/24/25)
    - Related Jobs

  • RN Clinical Manager, Home Health

    CenterWell (Marietta, GA)
    …of Science in Nursing (BSN) strongly preferred. **License/Certifications:** + Active and unrestricted Registered Nurse ( RN ) license or Compact State RN ... clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the...A minimum of 2 years of experience as a Registered Nurse ( RN ). + Home… more
    CenterWell (09/28/25)
    - Related Jobs

  • Medical Claim Review Nurse…

    Molina Healthcare (Columbus, GA)
    …SKILLS & ABILITIES:** + Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years ... hours 6 AM to 6 PM (Team will work on set schedule) Looking for a RN with experience with appeals, claims review , and medical coding. **Job Summary** Utilizing… more
    Molina Healthcare (09/06/25)
    - Related Jobs

  • Infusion Referral Nurse Sr- REMOTE

    Prime Therapeutics (Atlanta, GA)
    …Patient Programs. **Minimum Qualifications** + Associates - Nursing + Bachelors - Nursing + RN - Registered Nurse , State and/or Compact State Licensure - ... for work visa or residency sponsorship **Additional Qualifications** + Registered Nurse ( RN ). + 5...Experience in managed care, specialty drugs, care management and utilization review . + Meets Credentialing criteria. +… more
    Prime Therapeutics (09/04/25)
    - Related Jobs