- Humana (Atlanta, GA)
- …where your clinical expertise and passion for accuracy will make a meaningful impact. As the Nurse Audit Manager , you will spearhead audit and validation ... relevant coding. + Identifies the root cause analysis of audit findings and submits recommendations for appropriate change management....skills to make an impact** **Required Qualifications** + Registered nurse (RN). + 5 or more years of clinical… more
- Elevance Health (GA)
- ** Nurse Case Manager Senior - Field Nurse ** **Work location:** This field-based role located in the Albany, GA area enables associates to primarily operate ... 1 late evening shift 11:00am to 7:30pm EST. The ** Nurse Case Manager Senior - Field ...for new care management staff. + Participates in department audit activities. **Minimum requirements:** + Requires BA/BS in a… more
- Elevance Health (Atlanta, GA)
- **Telephonic Nurse Case Manager Senior** **Location:** This role enables associates to work virtually full-time, with the exception of required in-person ... in different states; therefore, Multi-State Licensure will be required.** The **Telephonic Nurse Case Manager Senior** is responsible for care management within… more
- Elevance Health (Atlanta, GA)
- The ** Nurse Case Manager ** **Lead** is responsible for care management within the scope of licensure for members with complex and chronic care needs by ... and functions as preceptor for new care management staff. + Participates in audit activities and assists supervisor with management of day-to-day activities, such as… more
- Molina Healthcare (GA)
- …programs. **Preferred Qualifications** * Certified Clinical Coder (CCC), Certified Medical Audit Specialist (CMAS), Certified Case Manager (CCM), Certified ... JOB DESCRIPTION **Job Summary** The Medical Claim Review Nurse provides support for medical claim review activities....Candidates with knowledge of CPT/HCPCS codes, record review, chart audit , provider disputes, appeals, and 1500 & UB04 claim… more
- Molina Healthcare (Columbus, GA)
- …**PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:** Certified Clinical Coder, Certified Medical Audit Specialists, Certified Case Manager , Certified Professional ... to clinical experience + Documents clinical review summaries, bill audit findings and audit details in the database + Provides supporting documentation for… more
- Molina Healthcare (GA)
- …Oversees interdisciplinary care team (ICT) meetings. * Functions as hands-on manager responsible for supervision and coordination of daily integrated healthcare ... and triage activities. * Ensures completion of staff quality audit reviews; evaluates services provided, outcomes achieved and recommends enhancements/improvements… more
- CVS Health (Atlanta, GA)
- …travel if a plan sponsor requests pharmacist attendance for an onsite visit/assessment/ audit . The Pharmacy Program Manager role includes: -Collaborate with an ... with heart, each and every day. The Pharmacy Program Manager is an individual contributor (non-people manager )...interdisciplinary care management team ( nurse case managers, medical directors, dietitians, social workers) to… more
- Elevance Health (Atlanta, GA)
- …coding principles, clinical guidelines, and objectivity in the performance of medical audit activities. + Draws on advanced ICD-10 coding expertise, mastery of ... clinical guidelines, and industry knowledge to substantiate conclusions. + Utilizes audit tools, auditing workflow systems and reference information to generate … more
- Stantec (Atlanta, GA)
- …work requirements and initiate appropriate measures with assigned project manager to facilitate project completion. - Maintain schedules, ensuring proper ... resources are allocated to each commissioning task. - Audit all sites during commissioning to ensure desired scope,...Qualifications and Experience - CEM or EMIT (Certified Energy Manager or Energy Manager in Training). -… more
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