- Trinity Health (Athens, GA)
- **Employment Type:** Part time **Shift:** **Description:** The Utilization Review (UR) Coordinator works, in collaboration with a multidisciplinary team that ... payers, to ensure patients progress along the continuum of care in an efficient and cost-effective manner that ensures...management and auditing duties as assigned. Participates in the Utilization Review Committee as assigned. Maintains good… more
- CVS Health (Atlanta, GA)
- … care **Preferred Qualifications** + NICU experience highly preferred + Managed care / utilization review experience + Ability to multitask, prioritize and ... Applies critical thinking and knowledge in clinically appropriate treatment, evidence-based care and medical necessity criteria for appropriate utilization of… more
- Fresenius Medical Center (Loganville, GA)
- **About this role:** As a Clinical Manager with Fresenius Medical Care , you will ensure that quality patient care is delivered while maintaining clinical ... will be part of a close-knit, collaborative team responsible for delivering unique care plans and providing dialysis treatment to patients facing end stage renal… more
- Fresenius Medical Center (Lithonia, GA)
- …regulatory and FMS policy requirements. Ensure provision of quality patient care while maintaining cost-effective clinical operations in accordance with all legal, ... Adheres to all requirements of the FMCNA Compliance Program, and FMS patient care and administrative policies as the clinical leader, has the authority to make… more
- CVS Health (Atlanta, GA)
- …. + Perform medical necessity reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse ( RN ) with at least 1 year of experience in ... a hospital setting. + A Registered Nurse that holds an active, unrestricted...of care . + 1+ years' experience in Utilization Review . + CCM and/or other URAC… more
- CVS Health (Atlanta, GA)
- … - Perform medical necessity reviews **Required Qualifications** - 5+ years' experience as a Registered Nurse ( RN ) with at least 1 year of experience in ... a hospital setting - A Registered Nurse that holds an active, unrestricted...of care - 1+ years' experience in Utilization Review - CCM and/or other URAC… 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
- Community Health Systems (Statesboro, GA)
- …+ 4-6 years of clinical nursing experience required + 3-5 years of experience in care management or utilization review required + 1-3 years of leadership ... to patient-centered care and continuous quality improvement. **Licenses and Certifications** + RN - Registered Nurse - State Licensure and/or Compact… more
- Centene Corporation (Atlanta, GA)
- …Family Therapist (LMFT) required or + Licensed Mental Health Professional (LMHP) required or + RN - Registered Nurse - State Licensure and/or Compact State ... and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and… more
- Centene Corporation (Atlanta, GA)
- …Family Therapist (LMFT) required or + Licensed Mental Health Professional (LMHP) required or + RN - Registered Nurse - State Licensure and/or Compact State ... Treatment Plans required. Knowledge of ABA services and BH utilization review process required. Experience working with...required. Experience working with providers and healthcare teams to review care services related to Applied Behavior… more
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