- CenterWell (Decatur, 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 (Atlanta, 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
- AdventHealth (Rome, GA)
- …need to succeed:** + Associate's of Nursing Required + 2 Work Experience Required + Registered Nurse ( RN ) Required This facility is an equal opportunity ... transitions, patient satisfaction, patient safety, readmission prevention and length of stay management . The RN Care Manager communicates daily with the… more
- Molina Healthcare (Savannah, GA)
- …health, pharmacy, etc.), or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... **JOB DESCRIPTION** **Job Summary** The Clinical Appeals Nurse ( RN ) provides support for internal...officer on denial decisions. * Resolves escalated complaints regarding utilization management and long-term services and supports… more
- HCA Healthcare (Savannah, GA)
- …experience preferred + InterQual experience preferred + Currently licensed as a Registered Nurse in the state(s) of practice according to law ... supporting a balance of optimal care and appropriate resource utilization . **What qualifications you will need:** + Bachelor's Degree...we encourage you to apply for our Manager Case Management opening. We promptly review all applications.… more
- Sharecare (Atlanta, GA)
- …appropriate resource utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during their interactions with participants ... learn more, visit www.sharecare.com . **Job Summary:** The Disease Management Nurse has the responsibility for supporting...with disabilities to perform the essential functions. + Current Registered Nurse multi-state compact license in the… more
- Datavant (Atlanta, GA)
- …job function as delegated by management Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well versed in DRG downgrade denials and ... of the Denial Prevention Specialist is to effectively defend utilization of available health services, review of...expertise successfully. Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well… more
- STG International (Milledgeville, GA)
- …regulations and guidelines that govern the facility. + Coordinate with the scheduler to ensure a Registered Nurse ( RN ) is on duty at least 8 hours a day/7 ... FUNCTIONS: + Ensure the facility meets the minimum staffing levels for nurses and nurse aides; complete required posting of nursing staff data as required. + Ensure… 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...experience in Managed Care **LICENSES or CERTIFICATIONS** **Required** + Registered Nurse **Preferred** + Certified Medical Coder… more
- Elevance Health (Columbus, GA)
- …required by law. Must have License to practice in the state of Georgia** The **Medical Management Nurse ** is responsible for review of the most complex or ... or case management experience and requires a minimum of 2 years clinical, utilization review , or managed care experience; or any combination of education and… more