- Molina Healthcare (GA)
- …and monitoring clinical and non-clinical team activities to facilitate integrated, proactive utilization management , ensuring compliance with regulatory and ... and Monitoring team responsible for prior authorizations, inpatient/outpatient medical necessity/ utilization review, and/or other utilization management … more
- Emory Healthcare/Emory University (Atlanta, GA)
- …campus. Monday-Friday** The ** Utilization Review (UR) Specialist** is a Registered Nurse responsible for conducting thorough medical necessity reviews to ... and Federal regulatory requirements as designated in Emory Healthcare's Utilization Management Plan. + Maintains all required...review experience. + Must have a valid, active unencumbered Registered Nurse license approved by the Georgia… more
- Evolent (Atlanta, GA)
- …and as an RN - **Required** + Minimum of 5 years in Utilization Management , health care Appeals, compliance and/or grievances/complaints in a quality ... appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and...part of the application process. This is collected for compliance and security purposes and only reviewed if an… more
- AdventHealth (Calhoun, GA)
- …Whitfield, Catoosa, Murray, Floyd and Bartow. **The role you'll contribute:** The Home Health Registered Nurse ( RN ) Care Manager is a professional nurse ... and directs the home care patient's care based on individual patient needs. The RN Care Manager is responsible for independent management of the Home Health… more
- Fresenius Medical Center (Lithonia, GA)
- …appropriate training according to FMS policy, including training to ensure ongoing compliance with all FMS risk management initiatives. + Provides opportunities ... vision, core values and customer service philosophy. Adheres to the FMCNA Compliance Program, including following all regulatory and FMS policy requirements. Ensure… more
- Fresenius Medical Center (Loganville, GA)
- …Classification of Disease (ICD) coding. + Manages clinic financials including efficient utilization of supplies or equipment and regular profits and loss review. + ... PHYSICIANS: + Facilitates the application process for physician privileges and compliance with Fresenius Medical Care Medical Staff By-Laws. + Responsible for… more
- CVS Health (Atlanta, GA)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... barriers to meeting goals and objectives. + Utilizes case management processes in compliance with regulatory and...reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse with at least 1 year… more
- Fresenius Medical Center (Augusta, GA)
- …under the direction of the Facility Manager, Director of Nursing and/or Charge Registered Nurse , utilizing standard nursing techniques to assist the physician in ... core values and customer service philosophy. Adheres to the Organization Compliance Program, including following all regulatory and Organization policy requirements.… more
- Humana (Atlanta, GA)
- **Become a part of our caring community and help us put health first** The Utilization Management Registered Nurse 2 utilizes clinical nursing skills to ... determination of the appropriate courses of action. The SNF Utilization Management Registered Nurse...skills to make an impact** **Required Qualifications** + **Licensed Registered Nurse ( RN )** in the… more
- Fresenius Medical Center (Bremen, GA)
- …+ Assists with implementing appropriate training according to policy; ensure ongoing compliance with all risk management initiatives. + Responsible for ... staff training, equipment, physician and patient relations, cost containment, supply management , medical records, patient billing, OSHA and all company, state and… more