• Regional Field Director, RNS Program…

    United Therapeutics (Atlanta, GA)
    …experience, including ICU and critical care of PAH, cardiology or pulmonology patients + Registered Nurse ( RN ) - State Licensure and/or Compact State ... Licensure RN - Registered Nurse - State Licensure and/or Compact...Demonstrated high competency in clinical understanding, team collaboration, team management , UT policies, and team/individual team compliance more
    United Therapeutics (08/10/25)
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  • Clinical Reviewer, Nurse

    Evolent (Atlanta, GA)
    Registered Nurse + Associate or Bachelors in Nursing (Must be a Registered Nurse ) + Experience as an RN in a Pain MNGT setting is preferred. + Strong ... , you will be a key member of the utilization management team. We can offer you...Nurse , you will routinely interact with leadership and management staff, other CR's (Clinical Reviewers), providers, office staff… more
    Evolent (08/19/25)
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  • Clinical Program Manager- Payment Integrity…

    Molina Healthcare (Macon, GA)
    **Job Summary** **_For this position we are seeking a ( RN ) Registered Nurse who must be licensed for the state of KENTUCKY or have a compact license._** ... Nursing experience, including hospital acute care/medical experience (STRONGLY DESIRED)** + ** Registered Nurse with Claims and CIC coding experience (STRONGLY… more
    Molina Healthcare (08/14/25)
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  • Clinical Reviewer, Nurse -Surgery

    Evolent (Atlanta, GA)
    …Doing:** As a Clinical Reviewer, Nurse , you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... Clinical Reviewers are supported by Field Medical Directors (MDs) in the utilization management determination process. + Reviews charts and analyzes clinical… more
    Evolent (08/19/25)
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  • Primary Care Physician Lead

    CenterWell (Savannah, GA)
    …to the strategic intent Overseeing other clinicians which includes Physicians, Advanced Registered Nurse Practitioners (ARNP), and Physicians Assistants (PA) in: ... opportunities for education/coaching + Identifying trends and areas of opportunity in pharmacy utilization (pharmacy management ) to impact Part D per Member per… more
    CenterWell (06/27/25)
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  • VP, Clinical Operations

    Molina Healthcare (Augusta, GA)
    Registered Nursing ( RN ) license in good standing. + Utilization Management Certification (CPHM) Certified Professional in Health Care Quality (CPHQ), ... management initiatives and analytical studies aimed at optimizing utilization of medical resources and maximizing operational efficiencies. + Engages with… more
    Molina Healthcare (07/17/25)
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  • Nurse Investigator

    State of Georgia (Fulton County, GA)
    …experience in the analysis of medical services documentation and related claims 2) Utilization Review 3) Case Management 4) Analysis of CPT codes and/or ... Nurse Investigator Georgia - Fulton - Atlanta (https://ga.referrals.selectminds.com/jobs/64040/other-jobs-matching/location-only) Hot… more
    State of Georgia (06/19/25)
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  • Transplant Nurse II (US)

    Elevance Health (Atlanta, GA)
    …solving with providers, claims or service issues. + Assists with development of utilization /care management policies and procedures. + Within the medical ... **Transplant Nurse II** **Location:** Virtual: This role enables associates...II** will be responsible for providing case and/or medical management for members receiving transplant services. Continue to learn… more
    Elevance Health (08/08/25)
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  • Sr, Manager, Performance Partners

    BD (Becton, Dickinson and Company) (Madison, GA)
    …our never-ending quest for innovation, BD continues to develop innovative hemodynamic management solutions that enable clinicians to provide better care to patients ... at the facility and system level to ensure sustained compliance . Manage the effective data set necessary to develop...US Sales force, Global Marketing Team) on the effective utilization of facility and system specific outcome data that… more
    BD (Becton, Dickinson and Company) (08/14/25)
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  • Atlanta Market - Medical Director

    ChenMed (Atlanta, GA)
    …more distinct markets within a designated region. As a member of the Executive Management team, the incumbent in this role, in close collaboration with the Regional ... reviews and executes clinical protocols, performance objectives, productivity benchmarks, compliance measures, provider workflow planning and provider scheduling across… more
    ChenMed (06/03/25)
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