- Emory Healthcare/Emory University (Atlanta, GA)
- …mentorship, _development,_ and leadership programs + And more **Description** We're seeking an ** Inpatient Registry Utilization Review Nurse (PRN)** who is ... physician and/or physician advisor. This individual will: + Perform utilization review by completing a timely and... review by completing a timely and comprehensive review of all new observation and inpatient … more
- Centene Corporation (Atlanta, GA)
- …and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and ... appropriateness in accordance with regulatory guidelines and criteria + Performs concurrent review of behavioral health (BH) inpatient to determine overall… more
- Molina Healthcare (Savannah, GA)
- …* At least 2 years experience, including experience in hospital acute care, inpatient review , prior authorization, managed care, or equivalent combination of ... JOB DESCRIPTION Job SummaryProvides support for clinical member services review assessment processes. Responsible for verifying that services are...relevant education and experience. * Registered Nurse (RN). License must be active and unrestricted… more
- Molina Healthcare (GA)
- …of the following activities: care review , care management, utilization management (prior authorizations, inpatient /outpatient medical necessity, etc.), ... in some or all of the following functions: care management, utilization management, behavioral health, care transitions, long-term services and supports (LTSS),… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …programs + And more **Description** We're seeking an **Bed Planning Coordinator Registered Nurse** provides 24/7 coverage for the Capacity Command Center. + ... for all EHC operating units, coordinating room assignments to optimize bed utilization across the health system, critically thinking to manage appropriate patient… more
- Molina Healthcare (Columbus, GA)
- …SKILLS & ABILITIES:** + Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years ... Assists with Complex Claim review including DRG Validation, Itemized Bill Review , Appropriate Level of Care, Inpatient Readmission, and any opportunity… more
- Molina Healthcare (GA)
- …integrated) performing one or more of the following activities: care review / utilization management (prior authorizations, inpatient /outpatient medical ... Collates and reports on Care Access and Monitoring statistics including plan utilization , staff productivity, cost effective utilization of services, management… more
- Prime Therapeutics (Atlanta, GA)
- …clinical experience. + Experience in managed care, specialty drugs, care management and utilization review . + Meets Credentialing criteria. + At minimum must ... to patients seeking care at non-preferred treatment sites (eg, Hospital inpatient or outpatient facilities, non-par cancer treatment centers, etc.). + Discusses… more
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