- Actalent (Atlanta, GA)
- …AM-5:00 PM (Rotating weekends) About the Role We are seeking a detail-oriented and compassionate Utilization Review Registered Nurse (RN) to join our ... Job Title: Utilization Review RN Location: Buckhead, GA (on-site position) Schedule: Monday-Friday, 8:30… more
- Humana (Atlanta, GA)
- …impact** **Use your skills to make an impact** **Required Qualifications** + **Licensed Registered Nurse (RN)** in the (appropriate state) with no disciplinary ... caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing...in an acute care setting + Previous experience in utilization management/ utilization review for a… more
- CVS Health (Atlanta, GA)
- …+ Perform medical necessity reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse with at least 1 year of experience in a hospital ... setting. + A Registered Nurse that holds an active, unrestricted...lower levels of care. + 1+ years' experience in Utilization Review . + CCM and/or other URAC… more
- State of Georgia (GA)
- Complnc Specialist 3 - Registered Nurse Georgia (https://ga.referrals.selectminds.com/jobs/75386/other-jobs-matching/location-only) New Hot Regulatory ... federal rules and regulations + Develops, implements, and evaluates the surveillance of utilization review process to ensure quality services + Monitors, tracks,… more
- Fresenius Medical Center (Woodstock, GA)
- …all FMS manuals. + Accountable for completion of the Annual Standing Order Review and ICD coding. + Checks correspondence whether electronic, paper or voice mail, ... supporting billing and collection activities. + Responsible for efficient utilization of medication, laboratory, inventory, supplies and equipment to achieve… more
- Fresenius Medical Center (Gainesville, GA)
- …auditing activities. + Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. + Manages clinic ... financials including efficient utilization of supplies or equipment and regular profits and...of supplies or equipment and regular profits and loss review . + Responsible for all required network reporting and… 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), ... and/or coding experience, or equivalent combination of relevant education and experience. + Registered Nurse (RN). License must be active and unrestricted in… more
- STG International (Milledgeville, GA)
- …regulations and guidelines that govern the facility. + Coordinate with the scheduler to ensure a Registered Nurse (RN) is on duty at least 8 hours a day/7 day a ... FUNCTIONS: + Ensure the facility meets the minimum staffing levels for nurses and nurse aides; complete required posting of nursing staff data as required. + Ensure… more
- Battelle Memorial Institute (Fort Benning, GA)
- …two years' nursing experience + Current, full, active, and unrestricted license as a Registered Nurse in any US State, the District of Columbia, Guam, Puerto ... (HRA) business line is seeking a highly motivated, full-time ** Nurse Case Manager** to join our team in support...professional parameters + Knowledge and skill in using pre-established utilization review criteria to recognize and report… more
- Evolent (Atlanta, GA)
- …the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. Tasks ... physician-developed medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care… more
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