• Medical Claim Review…

    Molina Healthcare (Columbus, GA)
    …Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years of experience in ... schedule) Looking for a RN with experience with appeals, claims review , and medical coding....clinical/ medical reviews of retrospective medical claim reviews, medical claims and… more
    Molina Healthcare (09/06/25)
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  • Nurse Investigator

    State of Georgia (Fulton County, GA)
    …additional experience in the analysis of medical services documentation and related claims 2) Utilization Review 3) Case Management 4) Analysis of CPT codes ... Nurse Investigator Georgia - Fulton - Atlanta (https://ga.referrals.selectminds.com/jobs/64040/other-jobs-matching/location-only)...clinical experience AND one (1) year experience working with medical claims . Preference will be given to… more
    State of Georgia (06/19/25)
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  • Case Manager, Registered Nurse - Fully…

    CVS Health (Atlanta, GA)
    …within time zone of residence.** American Health Holding, Inc (AHH) is a medical management company that is a division within Aetna/CVS Health. Founded in 1993, ... Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that support cost-effective quality care for members.… more
    CVS Health (08/15/25)
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  • UM Behavioral Health Nurse

    Humana (Atlanta, GA)
    …action. + Complete medical record reviews + Assess discharge plans + Review and extract information from claims + Complete documentation for Quality Reviews ... the appropriate courses of action. The Utilization Management Behavioral Health Nurse 2 completes medical record reviews from medical records sent from… more
    Humana (09/09/25)
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  • Clinical Appeals Nurse (RN)

    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, ... the likelihood of a formal appeal being submitted. + Independently re-evaluates medical claims and associated records by applying advanced clinical knowledge,… more
    Molina Healthcare (08/15/25)
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  • Clinical Fraud Investigator II - Registered…

    Elevance Health (Atlanta, GA)
    …and abuse prevention and control. + Review and conducts analysis of claims and medical records prior to payment. Researches new healthcare-related questions ... **Clinical Fraud Investigator II - Registered Nurse and CPC - Calrelon Payment Integrity SIU**...Integrity, is determined to recover, eliminate and prevent unnecessary medical -expense spending. The **Clinical Fraud Investigator II** is responsible… more
    Elevance Health (09/11/25)
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  • Telephonic RN Nurse Case Manager I

    Elevance Health (Atlanta, GA)
    **Telephonic RN Nurse Case Manager I** **Sign On Bonus: $3000** **Location: This role enables associates to work virtually full-time, with the exception of required ... in different states; therefore Multi-State Licensure will be required.** The **Telephonic Nurse Case Manager I** is responsible for performing care management within… more
    Elevance Health (09/11/25)
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  • Telephonic Nurse Case Manager II

    Elevance Health (Atlanta, GA)
    **Telephonic Nurse Case Manager II** **Location: This role enables associates to work virtually full-time, with the exception of required in-person training ... hours of receipt and meet the criteria._** The **Telephonic Nurse Case Manager II** is responsible for care management...management plan and modifies as necessary. + Interfaces with Medical Directors and Physician Advisors on the development of… more
    Elevance Health (09/11/25)
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  • Telephonic Nurse Case Manager II

    Elevance Health (GA)
    **Telephonic Nurse Case Manager II** **Location: This role enables associates to work virtually full-time, with the exception of required in-person training ... of receipt and meet the criteria._** ​ The **Telephonic Nurse Case Manager II** is responsible for care management...management plan and modifies as necessary. + Interfaces with Medical Directors and Physician Advisors on the development of… more
    Elevance Health (09/09/25)
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  • Sr VP Medical Director (Hourly)

    Sedgwick (Atlanta, GA)
    …review process including making a recommendation of specialty for the Independent Medical Review process. + Developing and delivering training materials and ... Best Workplaces in Financial Services & Insurance Sr VP Medical Director (Hourly) The ideal candidate would work 8-20...the following: + Conducting reviews on cases where the nurse is seeking treatment plan clarification, claim … more
    Sedgwick (08/22/25)
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