- Highmark Health (Atlanta, GA)
- …of the claim rejection and the proper action to complete the retrospective claim review with the goal of proper and timely payment to provider and member ... Payment Integrity strategies on a pre-payment and retrospective claims review basis. Review process includes a ...data to assure appropriate level of payment and resource utilization . It is also used to identify issues which… more
- Datavant (Atlanta, GA)
- …healthcare. The purpose of the Denial Prevention Specialist is to effectively defend utilization of available health services, review of admissions for medical ... expertise successfully. Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well versed in...letter Identification of referrals to the medical director for review + Select appropriate preferred and contracted providers +… more
- CenterWell (Atlanta, GA)
- …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and ... the utilization of Performance Improvement principles. + Responsible for review of the appropriate number of Case Managers and clinical staff documentation… 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 ... an organization that invests in you as a Registered Nurse (RN) Case Manager? At Memorial Health University Medical...a difference. We are looking for a dedicated Registered Nurse (RN) Case Manager like you to be a… more
- Veterans Affairs, Veterans Health Administration (Atlanta, GA)
- …on current administrative guidelines. Coordinates with the patient care team to review clinic appointment availability ( utilization ) to ensure that clinic ... coordinated care delivery model. Coordinates with the patient care team to review clinic appointment availability ( utilization ) to ensure that clinic schedules… more
- 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 ... you have the PRN career opportunities as a **Registered Nurse (RN) Case Manager** you want with your current...apply for our RN Case Manager PRN opening. We review all applications. Qualified candidates will be contacted for… more
- CenterLight Health System (Bostwick, GA)
- …of experience in care/case management, disease management, population health management, utilization review , quality assurance, or discharge planning (preferably ... clinical onboarding and reassessment, UAS-NY completion, comprehensive assessment, medication review , and post-hospital discharge evaluation. The Clinical Assessment Manager… more
- CenterWell (Atlanta, GA)
- …intent Overseeing other clinicians which includes Physicians, Advanced Registered Nurse Practitioners (ARNP), and Physicians Assistants (PA) in: + Maintaining ... inquiries, requests, and complaints from patients + Ongoing chart review / audit of clinical staff to ensure quality...+ Identifying trends and areas of opportunity in pharmacy utilization (pharmacy management) to impact Part D per Member… more
- Houston Methodist (GA)
- …caring for adults in an acute care hospital setting is required; coding and utilization review experience preferred + For Medical School graduate - One year ... **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure and/or Compact State Licensure...Licensure within 60 days **OR** + RN-Temp - Registered Nurse - Temporary State Licensure within 60 days +… more
- PruittHealth (Atlanta, GA)
- …years industry experience in a managed care setting focused on experience in utilization review /case management and at least two years case management, home ... for each patient based on a thorough history and clinical record review , including the attending physician's plan, the recommendations of national guidelines, social… more
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