- 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...skills to make an impact** **Required Qualifications** + **Licensed Registered Nurse ( RN )** in the… more
- Molina Healthcare (Savannah, GA)
- …authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... room. Previous experience in managed care Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG guidelines. Preferred… more
- Molina Healthcare (Macon, GA)
- …for internal meetings. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse ( RN ). **Required Experience** 1-3 years of ... clinic experience. **Required License, Certification, Association** Active, unrestricted State Registered Nursing ( RN ) license in good standing....Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and… more
- Fresenius Medical Center (Carrollton, GA)
- …and acts as the liaison for patient care as per the disease management agreement, including initial and ongoing validation of member eligibility. Facilitate timely ... workup of patients for access management , dialysis services, patient education, hospitalizations, and kidney transplantation as appropriate, and ensures coordination… more
- Fresenius Medical Center (Lithonia, GA)
- …auditing activities. + Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. + Manages clinic ... financials including efficient utilization of supplies or equipment and regular profits and...of supplies or equipment and regular profits and loss review . + Responsible for all required network reporting and… more
- Actalent (Atlanta, GA)
- Job Title: Utilization Review - FULLY REMOTE Job...Appeals, and Risk Management . Essential Skills + Registered Nurse ( RN ) with a ... GA or Compact. + 1+ years of experience in Utilization Management (UM). + 1+ years of...+ Experience with MCG or Interqual is preferred. + Utilization review experience is a plus. Work… more
- CVS Health (Atlanta, GA)
- …is subject to change based on business needs. **Preferred Qualifications** 6+ months Case Management or Utilization Management experience Case Management ... however, it is subject to change based on business needs.** The RN Case Manager is responsible for telephonically assessing, planning, implementing, and coordinating… more
- HCA Healthcare (Augusta, GA)
- **Description** **Introduction** Do you have the PRN career opportunities as a ** Registered Nurse ( RN ) Case Manager** you want with your current employer? We ... expertise! **Job Summary and Qualifications** We are seeking a Registered Nurse ( RN ) Case Manager...required for this PRN role. + Certification in Case Management or Utilization Review is… more
- HCA Healthcare (Savannah, GA)
- …candidates! Do you want to join an organization that invests in you as a Registered Nurse ( RN ) Case Manager? At Memorial Health University Medical Center, ... make a difference. We are looking for a dedicated Registered Nurse ( RN ) Case Manager... management is required. + Certification in case management or utilization review is… more
- Emory Healthcare/Emory University (Decatur, GA)
- …**Description** We're seeking a **Clinical Utilization Review Nurse Preceptor ( Registered Nurse / RN )** . This individual will be responsible for ... training, mentoring, and coaching for the Utilization Review Department and must be an...experience in UR. + Minimum 1 year as UR RN II or equivalent experience. + Case Management… more