- Actalent (Atlanta, GA)
- …PM (Rotating weekends) About the Role We are seeking a detail-oriented and compassionate Utilization Review Registered Nurse (RN) to join our team. In ... Utilization Review RN (Critical Care) Location:... Utilization Review RN (Critical Care) Location: Buckhead, GA (On-Site...+ BSN degree required. + Minimum 1 year of utilization review experience. + Minimum 1 year… 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 ... **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
- Actalent (Atlanta, GA)
- …internal teams (claims, benefits, appeals, risk management). Qualifications: + 1+ years of utilization management / utilization review / case management ... ,GA Must be Located closer to Atlanta, GA Job Description: + Review and approve precertification and medical necessity for designated referrals, procedures, and… 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 ... our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination,… more
- Molina Healthcare (Macon, GA)
- …At least 2 years clinical nursing experience, including at least 1 year of utilization review , medical claims review , long-term services and supports (LTSS), ... **Job Summary** Provides support for medical claim and internal appeals review activities - ensuring alignment with applicable state and federal regulatory… more
- STG International (Milledgeville, GA)
- …FUNCTIONS: + Ensure the facility meets the minimum staffing levels for nurses and nurse aides; complete required posting of nursing staff data as required. + Ensure ... reports, evaluations, studies, charting, etc., as necessary. + Periodically review the department's policies and procedures manuals, job descriptions,...+ Coordinate with the scheduler to ensure a Registered Nurse (RN) is on duty at least 8 hours… more
- Battelle Memorial Institute (Fort Benning, GA)
- …within legal and professional parameters + Knowledge and skill in using pre-established utilization review criteria to recognize and report actual or potential ... (HRA) business line is seeking a highly motivated, full-time ** Nurse Case Manager** to join our team in support...programs for equal treatment of all staff and full utilization of all qualified employees at all levels within… more
- Elevance Health (Atlanta, GA)
- …4 years managed care experience and requires a minimum of 2 years clinical, utilization review , or case management experience; or any combination of education ... is granted as required by law. The **Medical Management Nurse ** is responsible for review of the...in multiple states. **Preferred Skills, Capabilities & Experiences:** + Utilization management experience. + Strong of computer skills. For… more
- CVS Health (Atlanta, GA)
- …with transferring patients to lower levels of care. + 1+ years' experience in Utilization Review . + CCM and/or other URAC recognized accreditation preferred. + ... AHH is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that support… more
- Elevance Health (Atlanta, GA)
- …fraud and over- utilization by performing medical reviews via prepayment claims review and post payment auditing + Correlates review findings with appropriate ... ** Nurse Auditor Senior - Payment Integrity Complex and...responsible for identifying, monitoring, and analyzing aberrant patterns of utilization and/or fraudulent activities by health care providers through… more