- CVS Health (Atlanta, GA)
- …and administration of the utilization /benefit management function. Required Qualifications + Registered Nurse in state of residence. + 3+ years of Nursing ... experience. Preferred Qualifications + Prior authorization utilization management/ review experience preferred Outpatient Clinical experience. + Knowledge of… 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
- Humana (Atlanta, GA)
- …an impact** **Required Qualifications** **Must meet one of the following:** + Active unrestricted registered nurse license in the state of Virginia or obtain a ... problem-solving skills, facilitation skills **Preferred Qualifications** + Experience with utilization review process + Experience with behavioral change,… more
- PruittHealth (Atlanta, GA)
- …years industry experience in a managed care setting focused on experience in utilization review /case management and at least two years case management, home ... with long-term care population **MINIMUM LICENSURE/CERTIFICATION REQUIRED BY LAW:** * Licensed Registered Nurse with current, unrestricted license in state of… more
- Molina Healthcare (Atlanta, GA)
- …**JOB QUALIFICATIONS** **Required Education** Any of the following: Completion of an accredited Registered Nurse (RN), Licensed Vocational Nurse (LVN) or ... in good standing Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual /… more
- Fresenius Medical Center (Woodstock, 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 (Atlanta, GA)
- …Practical Nurse (LPN) Program **Required Experience** + Minimum two years Utilization Review experience. + Knowledge of audit processes and applicable state ... in good standing. **Preferred Education** Completion of an accredited Registered Nurse (RN) Program or a bachelor's degree in Nursing. **Preferred Experience**… more
- Molina Healthcare (Atlanta, GA)
- …Managed Care Experience in the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and Support, ... outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical/medical reviews of previously denied cases… more
- Molina Healthcare (Atlanta, GA)
- …**JOB QUALIFICATIONS** **Required Education** Any of the following: Completion of an accredited Registered Nurse (RN), Licensed Vocational Nurse (LVN) or ... clinic experience. **Required License, Certification, Association** Active, unrestricted State Registered Nursing (RN), Licensed Vocational Nurse (LVN) or… more
- Molina Healthcare (Atlanta, GA)
- **JOB DESCRIPTION** Opportunity for experienced Utilization Review RN in United States who has a compact, multi-state license. This team reviews the prior ... requests for transplants; the ideal candidate will have experience either in utilization review or case management for transplants. Preference will be… more