- Humana (Atlanta, GA)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are varied… more
- CVS Health (Atlanta, GA)
- …Must have active current and unrestricted RN licensure in state of residence. + Utilization Management is a 24/7 operation and work schedules will include ... in med surg or specialty area- + Managed Care experience preferred, especially Utilization Management + Preference for those residing in EST zones **Education**… more
- Elevance Health (Atlanta, GA)
- ** Utilization Management Representative II** **Location :** Seeking candidates that reside within 50 miles of the **Atlanta, GA** or **Columbus, GA** PulsePoint ... days per week will be during these hours.** The ** Utilization Management Representative II** is responsible for...given. + Refers cases requiring clinical review to a nurse reviewer; and handles referrals for specialty care. +… more
- Emory Healthcare/Emory University (Duluth, GA)
- …mentorship, _development,_ and leadership programs + And more **Description** The Utilization Review (UR) Specialist is responsible for conducting medical necessity ... the attending physician and/or physician advisor. + The UR Specialist will perform utilization review by completing a timely and comprehensive review of all new… more
- Humana (Atlanta, GA)
- …Previous Medicare/Medicaid experience a plus. + Previous experience in prior authorization, utilization management + Experience working with MCG or Interqual ... goal to put health first? The Prior Authorization, Registered Nurse , RN, Intern will review prior authorization requests for...review depending on case findings. + Educates providers on utilization and medical management processes. + Enters… more
- State of Georgia (Fulton County, GA)
- …Specific, additional experience in the analysis of medical services documentation and related claims 2 ) Utilization Review 3) Case Management 4) Analysis of ... Nurse Investigator Georgia - Fulton - Atlanta (https://careers.georgia.gov/jobs/64040/other-jobs-matching/location-only)...services. Position requires an active RN License AND two ( 2 ) years of clinical experience AND one (1) year… more
- ChenMed (Decatur, GA)
- …expanding and we need great people to join our team. The Registered Nurse , Telehealth is responsible for providing telephonic triage directional patient care advice ... issues, client counseling, patient advocacy, health education and referral and resource management to ChenMed patients and their families. The incumbent in this role… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …stakeholders to manage transport requests, prioritize urgent cases, and optimize resource utilization . + The transport coordinator serves as a central point of ... all transport requests, transport, and transport system status. + 2 . Communication: - Act as a liaison between EMS...any issues or delays in transport. + 3. Resource Management : - Monitor and manage the availability of ambulances,… more
- Molina Healthcare (Atlanta, GA)
- … and effective resource management . + Develops and implements a Utilization Management program and action plan, which includes strategies that ensure ... IT and data analysts to produce tools to report, monitor and improve Utilization Management . + Actively participates in regulatory, professional and community… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …seeking a **Procedural Service Line Coordinator, Cardiovascular Operating Room (Registered Nurse / RN)** responsible for the overall daily operations of assigned ... This individual: + Coordinates daily operations, staffing, and case flow and management of inventory, instruments, supplies and equipment for selected service line… more