- Evolent (Atlanta, GA)
- …Evolent for the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior ... policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as... medical necessity and appropriateness of services using clinical review criteria. + Accurately documents all… more
- Fresenius Medical Center (Atlanta, GA)
- **About this role:** As a Clinical Manager with Fresenius Medical Care, you will ensure that quality patient care is delivered while maintaining clinical ... kidney disease. **Training and advancement:** You will enter our Clinical Leadership Program that creates and supports a culture...a tremendous asset that sets us apart. At Fresenius Medical Care, you will truly make a difference in… more
- Cognizant (Atlanta, GA)
- …necessity determinations to the Health Plan/ Medical Director based on the review of clinical documentation in accordance with Medicare, Medicaid, and ... as well as timely filing deadlines and processes. + Review clinical denials including but not limited...thinking skills to interpret guidelines of internal policies for clinical determination. + Medical Necessity Reviews can… more
- Molina Healthcare (Atlanta, GA)
- **Job Description** **Job Summary** Provides support for medical claim and internal appeals review activities - ensuring alignment with applicable state and ... quality and cost-effective member care. **Job Duties** + Facilitates clinical / medical reviews of retrospective medical ...nursing experience, including at least 1 year of utilization review , medical claims review , long-term… more
- Elevance Health (Atlanta, GA)
- ** Nurse Auditor Senior - Payment Integrity Complex and Clinical Audit** **Location:** This role enables associates to work virtually full-time, with the ... formerly Payment Integrity, is determined to recover, eliminate and prevent unnecessary medical -expense spending. The ** Nurse Audit Senior** will be responsible… more
- Elevance Health (Atlanta, GA)
- ** Clinical Fraud Investigator II - Registered Nurse and CPC - Calrelon Payment Integrity SIU** **Location:** This role enables associates to work virtually ... Payment Integrity, is determined to recover, eliminate and prevent unnecessary medical -expense spending. The ** Clinical Fraud Investigator II** is responsible… more
- Elevance Health (Atlanta, GA)
- …states; therefore, Multi-State Licensure will be required.** The ** Medical Management Nurse ** is responsible for review of the most complex or challenging ... ** Medical Management Nurse ** **Location: Virtual: This...management experience and requires a minimum of 2 years clinical , utilization review , or managed care experience;… more
- ChenMed (Decatur, GA)
- …This position may require participation in risk and quality management programs, clinical meetings and other meetings. The Nurse Practitioner, Specialty ... nurse practitioner role. + Facilitate patient/family conferences to review treatment goals, optimize resource utilization, provide family education and identify… more
- Gentiva (Stockbridge, GA)
- …(LCD) criteria per hospice policy and regulatory requirements. + Communicate clinical findings, review treatment plans, lab results, diagnostics, and ... Partnerships. Transform Hospice Care.** We are seeking a dedicated Hospice Nurse Practitioner to perform Face-to-Face (F2F) encounters essential for hospice… more
- Dialysis Clinic, Inc. (Fayetteville, GA)
- …experience; experience preferred **Benefits:** + Paid training with preceptor + Charge nurse continuing education classes + Comprehensive medical , dental and ... and document orders + Participate in patient care conferences, medical rounds and chart review ; document progress...as directed and supervised by the education coordinator, the clinical supervisor and/or the nurse manager +… more
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