- Molina Healthcare (Atlanta, GA)
- For this position we are seeking a ( RN ) Registered Nurse who must hold a compact license. This is a Remote position, home office with internet connectivity ... least 2 years experience, including experience in hospital acute care , inpatient review , prior authorization, managed ...or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must… more
- Molina Healthcare (Atlanta, GA)
- …managed care , or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted in ... or emergency room. Preferred Experience Previous experience in managed care Prior Auth, Utilization Review / Utilization...experience in managed care Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual /… more
- Molina Healthcare (Atlanta, GA)
- …managed care , or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted in ... JOB DESCRIPTION Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically… more
- Emory Healthcare/Emory University (Decatur, GA)
- …**Unit Charge, Critical Care Stepdown LTAC** responsible for being a capable clinician who has acquired broad experience in caring for patients and has developed ... a sound understanding about the care of a particular patient population and routinely uses...experience to respond to changes in clinical situations. This RN professional is able to apply the Synergy Model… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …_development,_ and leadership programs + And more **Description** We're seeking a ** Registered Nurse , Vascular Access** responsible for being a capable ... RN professional can apply the Synergy Model for Care in practice and use this knowledge to personalize...to colleagues and strong advocate for them. + Capable clinician who has acquired broad experience in caring for… more
- Highmark Health (Atlanta, GA)
- …of experience in Managed Care **LICENSES or CERTIFICATIONS** **Required** + Registered Nurse **Preferred** + Certified Medical Coder or related **SKILLS** + ... and the proper action to complete the retrospective claim review with the goal of proper and timely payment...outcomes. Will monitor and analyze the delivery of health care services in accordance with claims submitted, and analyzes… more
- Datavant (Atlanta, GA)
- …with clinical knowledge and expertise successfully. Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well versed in DRG downgrade ... government agencies, and those who deliver and pay for care . By joining Datavant today, you're stepping onto a...by management Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …complete an ADN-to-BSN program within two years of entering the RN Clinician role. Licensure: + A valid, unencumbered Registered Nursing License approved by ... cancer screening - ( this location sends out the Prep Instructions and review any questions the patients may have). **Key Responsibilities:** Clinical Practice &… more
- Humana (Atlanta, GA)
- …a part of our caring community and help us put health first** The Appeals Nurse 2 resolves clinical complaints and appeals. The Appeals Nurse 2 work assignments ... and independent determination of the appropriate courses of action. The Appeals Nurse 2 reviews documentation and interprets data obtained from clinical records to… more
- Elevance Health (Atlanta, GA)
- …in different states; therefore, Multi-State Licensure will be required.** The **Medical Management Nurse ** is responsible for review of the most complex or ... **Medical Management Nurse ** **Location: Virtual: This role enables associates to...and requires a minimum of 2 years clinical, utilization review , or managed care experience; or any… more