- Emory Healthcare/Emory University (Atlanta, GA)
- …+ And more **Description** We're seeking under the direction of the ** Utilization Management Appeals Professional, Registered Nurse ** is responsible for managing ... duties and responsibilities: Participates in external reviews such as Medicare Recovery Audit Program or other third-party audit programs and defends Emory… more
- STG International (Milledgeville, GA)
- STGi is seeking a Licensed Practical Nurse /Licensed Vocational Nurse to provide services to our Georgia War Veterans Home. JOB SUMMARY: The primary purpose of ... 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
- Molina Healthcare (GA)
- **JOB DESCRIPTION** For this position we are seeking a (RN) Registered Nurse who must be licensed for the state they reside This position will support Medical Review ... outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical/medical reviews of previously denied cases… more
- Molina Healthcare (Columbus, GA)
- …decision making pertinent to clinical experience + Documents clinical review summaries, bill audit findings and audit details in the database + Provides ... of payment decisions. + Serves as a clinical resource for Utilization Management, Chief Medical Officers, Physicians, and Member/Provider Inquiries/Appeals. +… more
- 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...any blatant compliance issues. + Accurately documents findings from audit on standard forms. + Participates in interviews of… more
- Superior Court of Fulton County (Atlanta, GA)
- …court operations. Techniques used to conduct legal research. Requires skill in Data Utilization : Requires the ability to evaluate, audit , deduce, and/or assess ... clinical social worker, marriage and family therapist, psychologist, psychiatric nurse , rehabilitation counselor; (as required by position assignment). **_This job… more
- Superior Court of Fulton County (Atlanta, GA)
- …court operations. Techniques used to conduct legal research. Requires skill in Data Utilization : Requires the ability to evaluate, audit , deduce, and/or assess ... clinical social worker, marriage and family therapist, psychologist, psychiatric nurse , rehabilitation counselor. **Physical Requirements:** Physical Ability: Tasks require… more
- CenterWell (Savannah, GA)
- …intent Overseeing other clinicians which includes Physicians, Advanced Registered Nurse Practitioners (ARNP), and Physicians Assistants (PA) in: + Maintaining ... and complaints from patients + Ongoing chart review / audit of clinical staff to ensure quality care and...+ Identifying trends and areas of opportunity in pharmacy utilization (pharmacy management) to impact Part D per Member… more