- Emory Healthcare/Emory University (Decatur, GA)
- …_,_ and leadership programs + And more **Description** We're seeking a **Clinical Utilization Review Nurse Preceptor (Registered Nurse / RN)** . This individual ... will be responsible for training, mentoring, and coaching for the Utilization Review Department and must be an expert in the utilization review functions… more
- Actalent (Atlanta, GA)
- Utilization Review (Registered Nurse) Job Description This role involves performing precertification and medical necessity reviews for designated referrals and ... Skills & Qualifications + Experience with MCG or Interqual is preferred. + Utilization review experience is a plus. Job Type & Location This is a Contract… more
- Waystar (Atlanta, GA)
- …end user adoption of best practice workflows. We are specifically seeking an experienced Utilization Review Nurse who will serve as an integral contributor in ... **ABOUT THIS POSITION** The Clinical Product Consultant for Utilization Management is a member of the Customer...acute care setting + 2+ years of experience in utilization management + Knowledge and understanding of Utilization… more
- Humana (Atlanta, GA)
- …Coordinator or discharge planner in an acute care setting + Previous experience in utilization management/ utilization review for a health plan or acute care ... part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination,… more
- Elevance Health (Columbus, GA)
- …Alternate locations may be considered. The **Medical Director** will be responsible for utilization review case management for North Carolina Medicaid. May be ... be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US military… more
- Humana (Atlanta, GA)
- …new systems (proficient to advanced) **Preferred Qualifications** + Experience with Utilization Review and/or Prior Authorization, preferably within a managed ... first** The UM Administration Coordinator contributes to administration of utilization management. The UM Administration Coordinator 2 performs varied activities… more
- Centene Corporation (Atlanta, GA)
- …including a fresh perspective on workplace flexibility. **Position Purpose:** Authorize and review utilization of dental services provided in provider offices, ... + Monitor quality of care and collect and analyze utilization data + Serve as a resource between the...the health plan, provider relations, and dental providers + Review treatment plans and initial evaluations + Comply with… more
- Molina Healthcare (Savannah, GA)
- …care unit (ICU) or emergency room. Previous experience in managed care Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / ... JOB DESCRIPTION Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically… more
- Molina Healthcare (Atlanta, GA)
- …in a medical unit or emergency room. Previous experience in managed care Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / ... JOB DESCRIPTION Job SummaryProvides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary… more
- Molina Healthcare (Macon, GA)
- …Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual ... / MCG guidelines. **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). **MULTI STATE / COMPACT LICENSURE**… more
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