- Elevance Health (Columbus, GA)
- …Finder and follows up with provider on referrals given. + Refers cases requiring clinical review to a nurse reviewer; and handles referrals for specialty care. + ... ** Utilization Management Representative II** **Virtual:** This role enables...impact:** + Managing incoming calls or incoming post services claims work. + Determines contract and benefit eligibility; provides… more
- Sedgwick (Atlanta, GA)
- …Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance Quality Review Nurse **PRIMARY PURPOSE** : To monitor team and colleague technical ... related line of business experience in telephonic case management (TCM) and/or utilization review or equivalent combination of education and experience required.… more
- State of Georgia (Fulton County, GA)
- …1) Specific, additional experience in the analysis of medical services documentation and related claims 2) Utilization Review 3) Case Management 4) Analysis ... Nurse Investigator Georgia - Fulton - Atlanta (https://ga.referrals.selectminds.com/jobs/64040/other-jobs-matching/location-only) Hot… more
- Molina Healthcare (Savannah, GA)
- …1-3 years Managed Care Experience in the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and ... outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical/medical reviews of previously denied cases… more
- Elevance Health (Atlanta, GA)
- **Telephonic Nurse Case Manager II** **Location: This role enables associates to work virtually full-time, with the exception of required in-person training ... in different states; therefore, Multi-State Licensure will be required.** The **Telephonic Nurse Case Manager II** is responsible for care management within the… 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 ... hours of receipt and meet the criteria._** The **Telephonic Nurse Case Manager Senior** is responsible for care management...as applicable. + Assists in problem solving with providers, claims or service issues. + Assists with development of… more
- Elevance Health (GA)
- **Telephonic Nurse Case Manager II** **Location: This role enables associates to work virtually full-time, with the exception of required in-person training ... of receipt and meet the criteria._** The **Telephonic Nurse Case Manager II** is responsible for care management...as applicable. + Assists in problem solving with providers, claims or service issues. + Assists with development of… more
- Molina Healthcare (Macon, GA)
- …experience, including hospital acute care/medical experience (STRONGLY DESIRED)** + **Registered Nurse with Claims and CIC coding experience (STRONGLY DESIRED)** ... **_For this position we are seeking a (RN) Registered Nurse who must be licensed for the state of...Payment Integrity strategies through both pre-payment and post payment claims reviews, aligning with industry and corporate standards as… more
- Molina Healthcare (Atlanta, GA)
- …the Chief Medical Officer. + Evaluates authorization requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the ... and interacts with network and group providers and medical managers regarding utilization practices, guideline usage, pharmacy utilization and effective resource… more