- HCA Healthcare (Augusta, GA)
- …is required for this PRN role. + Certification in Case Management or Utilization Review is preferred. + InterQual experience is preferred. **Doctors Hospital ... encourage you to apply for our RN Case Manager PRN opening. We review all applications. Qualified candidates will be contacted for interviews. **Unlock the… more
- State of Georgia (Fulton County, GA)
- …or licensed/certified professional in a related field or setting . Experience in utilization review and/or quality assurance in a healthcare setting . Experience ... in conducting assessments and evaluations based on regulations, legal requirements and/or recognized accreditation standards . Experience in performing investigations and audits related to allegations that consist of gathering the appropriate information,… more
- CVS Health (Athens, GA)
- …your understanding of patient safety and error prevention, quality assurance drug utilization review (DUR), pharmacy professional standards such as corresponding ... responsibility and red flag detection. While in the pharmacy, you will assist the pharmacy team to ensure that pharmacy operations run smoothly, our patients' prescriptions are filled promptly, safely, and accurately, and we are providing caring service that… more
- Evolent (Atlanta, GA)
- …+ 2 years of Workforce Planning (WFM)experience in Healthcare Compliance, preferably Utilization Review Licensure **not required however preferred** + 5 years ... of Clinical or Workforce Planning experience + Possesses a high level of accountability in the achievement of client specific performance guarantee targets and internal service performance goals + Must have ability to work in a fast-paced environment while… more
- Emory Healthcare/Emory University (Peachtree City, GA)
- …in facility meetings as directed by Center Manager (may include utilization review , infection control, disaster preparedness, etc.). Communicate pertinent ... patient information to referring physicians, staff, employers, insurance carriers and rehabilitation specialists. Provide injured worker with guidelines for job modification and energy conservation in accordance with physician Custom fabricate splints/casts to… more
- Houston Methodist (GA)
- …caring for adults in an acute care hospital setting + Coding and utilization review experience preferred **LICENSES AND CERTIFICATIONS - REQUIRED** + RN ... - Registered Nurse - Texas State Licensure -- Compact Licensure - Must obtain permanent Texas license within 60 days (if establishing Texas residency) **LICENSES AND CERTIFICATIONS - PREFERRED** + CCDS - Clinical Documentation Specialists (ACDIS) **OR** + CDIP… more
- HCA Healthcare (Savannah, GA)
- …in hospital case management is required. + Certification in case management or utilization review is preferred. + InterQual experience is preferred. Memorial ... Health University Medical Center (https://memorialhealth.com/) has provided quality healthcare services since 1955, giving patients access to highly-trained physicians and advanced technology. Our600+ bed hospital is one of the region's leading acute care… more
- BrightSpring Health Services (Valdosta, GA)
- …report any discrepancies to BM. + Run monthly End of Month reports. + Run and review Utilization - Work all over utilized clients to prevent SVPs. + Time Detail ... Business Office Manager. + Web Portal Patient Monthly Liability Review monthly - send any changes to Business Office...+ Cross Train on End of Month procedure. + Review Expiring Auth Reports. + Supplies - ordering for… more
- Cognizant (Atlanta, GA)
- …and retro-authorization as well as timely filing deadlines and processes. . Review clinical denials including but not limited to referral, preauthorization, medical ... necessity determinations to the Health Plan/Medical Director based on the review of clinical documentation in accordance with Medicare, Medicaid, and third-party… more
- Elevance Health (Atlanta, GA)
- ** Utilization Management Representative I** **Virtual:** This role enables associates to work virtually full-time, with the exception of required in-person training ... employment, unless an accommodation is granted as required by law._ The ** Utilization Management Representative I** will be responsible for coordinating cases for… more