- ChenMed (Decatur, GA)
- …expanding and we need great people to join our team. The Registered Nurse , Telehealth is responsible for providing telephonic triage directional patient care advice ... issues, client counseling, patient advocacy, health education and referral and resource management to ChenMed patients and their families. The incumbent in this role… more
- Highmark Health (Atlanta, GA)
- …Nursing **EXPERIENCE** **Required** + 7 years in any combination of clinical, case/ utilization management and/or disease/condition management experience, or ... within the first 6 months of employment. **Preferred** + Certification in utilization management or a related field + Certification in Case Management … more
- Humana (Atlanta, GA)
- …Office products including Word, Excel and Outlook **Preferred Qualifications** + Utilization Review/Quality Management experience + Experience working with MCG ... community and help us put health first** The Appeals Nurse 2 resolves clinical complaints and appeals. The Appeals...programs + Bachelor's degree **Additional Information** **Work Style** : Remote **Work Days/Hours:** Monday - Friday; 8:00 am-5 pm… more
- US Tech Solutions (GA)
- **Job Description:** This is a remote position and requires the ability to effectively support a work from home environment. Must have the ability to work in a HIPAA ... is necessary and will involve computer system data entry, data management , and reporting. + Review criteria-based prior authorizations following policy and… more
- Molina Healthcare (Columbus, GA)
- …of payment decisions. + Serves as a clinical resource for Utilization Management , Chief Medical Officers, Physicians, and Member/Provider Inquiries/Appeals. ... that has a current active unrestricted license This a remote role and can sit anywhere within the United...3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review. + Minimum two… more
- Sharecare (Atlanta, GA)
- …/ new hire plan selection, claims issues, ID card issues, grievances/appeals, utilization management (UM) status, including but not limited to medical, ... the Family Health Advocate is an exciting and innovative remote role newly created to provide meaningful support to...+ Claims adjustments + Grievances and appeals submissions + Utilization management intake or status + Complex… more
- Molina Healthcare (GA)
- …healthcare services professionals in some or all the following functions: care management , utilization management , behavioral health, care transitions, ... beneficial Work hours: Monday- Friday 8:00am - 5:00pm EST Remote position; MUST reside in Georgia **Essential Job Duties**...+ Assists in implementing health management , care management , utilization management , behavioral health… more
- CenterWell (Marietta, GA)
- …driver's license, auto insurance and reliable transportation. + Two years as a Registered Nurse with at least one-year of management experience in a home care, ... **Position Type** : On-site **Branch Location** : Marietta, GA **This is not a remote or work-from-home position. This position requires you to sit on-site at our… more
- Lincoln Financial (Atlanta, GA)
- …in a behavioral health setting including 1 year in claims, disability management (STD/LTD), worker's compensation, utilization review, and or behavioral health ... Charlotte, NC (North Carolina); Omaha, NE (Nebraska); Work from Home **Work Arrangement:** Remote : Work at home employee residing outside of a commutable distance… more