- CenterWell (Atlanta, GA)
- …Physical Therapy, DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/ ... actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that… more
- CenterWell (Atlanta, GA)
- …or Orthopedic procedures + Compact License preferred + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/ ... actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that… more
- Centene Corporation (Atlanta, GA)
- …including treatment needs and appropriate level of care preferred. Knowledge of Medicare and Medicaid regulations preferred. Knowledge of utilization management ... discuss member care being delivered + Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member medical records in… more
- STG International (Milledgeville, GA)
- STGi is seeking a Licensed Practical Nurse /Licensed Vocational Nurse to provide services to our Georgia War Veterans Home. JOB SUMMARY: The primary purpose of ... FUNCTIONS: + Ensure the facility meets the minimum staffing levels for nurses and nurse aides; complete required posting of nursing staff data as required. + Ensure… more
- Molina Healthcare (Savannah, GA)
- …Managed Care Experience in the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and Support, ... outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical/medical reviews of previously denied cases… more
- 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
- Molina Healthcare (Atlanta, GA)
- …the Chief Medical Officer. + Evaluates authorization requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the ... and interacts with network and group providers and medical managers regarding utilization practices, guideline usage, pharmacy utilization and effective resource… more
- Humana (Atlanta, GA)
- …to medical directors and leadership during Medicare and Medicaid LOB - Medicare Clinical Criteria Review (MCCR), Utilization Management Committee (UMC), ... **Desired Qualifications** + Master's degree in health-or business-related field + Utilization management experience (Commercial and/or Medicare ) + Proven… more
- CenterWell (Duluth, GA)
- …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and ... delivery, and documentation requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking for performance … more
- 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._** Provides ... achieve operational goals and executes tasks and projects to ensure Centers for Medicare & Medicaid Services (CMS) and State regulatory requirements are met for… more