- CVS Health (Atlanta, GA)
- …Medical Director referral as needed. + Assists management with training new nurse reviewers/business partners or vendors to include initial and ongoing mentoring, ... client needs. + Recommends, tests, and implements process improvements, new audit concepts, technology improvements, etc. that enhance production, quality, and… 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 (Savannah, GA)
- …outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical/medical reviews of previously denied cases ... Medical Officer on denial decisions. + Resolves escalated complaints regarding Utilization Management and Long-Term Services & Supports issues. + Identifies and… more
- Elevance Health (Atlanta, GA)
- **Telephonic Nurse Case Manager Senior** **Location:** This role enables associates to work virtually full-time, with the exception of required in-person training ... assessment within 48 hours of receipt and meet the criteria._** The **Telephonic Nurse Case Manager Senior** is responsible for care management within the scope of… 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