Hybrid Review Nurse - Prior Authorization & UM (Medicaid)
Alliant Health Group
Alliant Health Group in Atlanta, Georgia, is seeking a Hybrid Review Nurse for its Prior Authorization and Utilization Management team. This role conducts prior approval and precertification reviews for Georgia Medicaid members. The ideal candidate will have a current Georgia nursing license and at least three years of recent clinical experience. We offer competitive benefits such as medical, dental, and retirement plans, along with a commitment to work/life balance and employee well-being. #J-18808-Ljbffr
- ...Description Are you a bedside nurse seeking a change from the... ...! Alliant is recruiting a Hybrid Review Nurse for its Prior Authorization and Utilization Management (PA/UM) team. The Review Nurse conducts... ...for Georgia Fee-for-Service Medicaid members for the team’s...SuggestedContract work
- ...Behavioral Health Registered Nurse (RN) Intern will report to a manager of the National Medicaid team. You will utilize training... ...complete medical necessity reviews for behavioral health requested... ...clinical reviews of prior authorization requests to determine medical...SuggestedFor contractorsApprenticeshipInternshipRemote workWork from homeHome officeWeekday work
- ...This position will be working a hybrid schedule that consists of days... ...accurately and efficiently. Prior experience in a similar role is... ...(s). Areas Of Responsibility Review and organize patient medical records... ...Assistant (CMA) or licensed nurse (i.e. LPN or RN). Must be...SuggestedFull timeRemote workMonday to FridayFlexible hours
$71.1k - $97.8k
...Utilization Management Registered Nurse uses clinical nursing skills... ...management/utilization review for a health plan or acute care... ...agency. Health Plan or Medicare / Medicaid Experience. Call center or triage... .... Humana will provide Home or Hybrid Home/Office employees with...SuggestedBi-weekly payFull timeTemporary workApprenticeshipRemote workHome office$43.5k - $48k
...Specialist (Subrogation) - Tucker, GA - Hybrid Date: May 5, 2026 Location: Tucker, GA,... ...casualty and estate functions involving state Medicaid beneficiaries or deceased Medicaid... ...responsible for the intake, maintenance, claims review, case management, settlement, and all...SuggestedFull timeContract workWork at officeMonday to FridayFlexible hours2 days per week$19.66 - $31.04 per hour
...note that per our policy on hybrid/virtual work, candidates not... ...management, case management, QI, Med Review). Provides information... ...of managed care or Medicaid/Medicare strongly preferred.... ...year of experience working with authorizations is preferred. Previous experience...Full timeTemporary workWork experience placementWork at officeLocal areaMonday to FridayShift work1 day per week$50 - $55 per hour
...Competitive hourly pay ($50-$55 / hr) Hybrid work structure with significant WFH flexibility... ...clinical documentation and oversee chart reviews. Assist with credentialing and quality... ...Graduate of an accredited nursing program; BSN preferred. Current Registered...Hourly payDaily paidWork at officeLocal areaFlexible hoursDay shift- ...experienced Registered Nurse looking for a new... ...Daily Responsibilities Review admissions through on-... ...Data enters assessments, authorizations and reviews into the system... ...Qualifications Prior Authorization experience... ...experience (Medicare, Medicaid, commercial) Additional...Private practiceMonday to Friday
- ...insights on health and welfare plans, and contribute to strategic design and renewals. This hybrid role requires in-office presence at least three days a week. The candidate will review analyses, support junior staff, and leverage Excel, SAS, and programming skills in R and...Work at office3 days per week
$28.94 - $51.63 per hour
...Registered Nurse Clinical Annotator At UnitedHealthcare, we'... ...designed to streamline and automate prior authorization processes in healthcare. This... .... General Job Profile Reviews the work of others... ...established utilization management (UM) guidelines Contribute to...Remote jobHourly payMinimum wageFull timeWork experience placementLocal area- ...promote excellence in customer service Administrative tasks, prior authorizations, etc. Skills & Qualifications: Strong phlebotomy... ...join our team! How To Get Started: To have your resume reviewed by someone on our Talent Acquisition team, click on the "Apply...Full timeWork at officeImmediate startMonday to Friday
- ...provider with an array of services: Skilled Nursing, Personal Care Services, Companionship... ...members receiving homecare services. Reviewing referrals, evaluating the member’s... ...Supervisory visits are not billable through Medicaid. QUALIFICATIONS: A current Georgia...
$40.35 - $51.59 per hour
...Responsible for carrying out medical necessity reviews on all designated referrals for Home... ...~ Minimum three (3) years of clinical nursing OR completed Kaiser Permanente Nurse... ...location must align with Kaiser Permanente's Authorized States policy. Kaiser Permanente is an...Contract workWork experience placementReliefWork at officeLocal areaImmediate startShift workWeekend work$59k - $75.05k
...Nurse Reviewer The Nurse Reviewer is primarily responsible for conducting post-service, pre or post payment in-depth claim reviews based on accepted medical guidelines and clinical criteria, billing and coding rules, plan policy exclusions, and payment errors/overpayments...Full timeWork at officeLocal areaVisa sponsorshipFlexible hours- ...nationwide to recruit qualified Registered Nurses for a variety of clinical opportunities.... ...environments Work Arrangement: On-site, hybrid, and remote opportunities may be available... ...your application. A recruiter will review your qualifications and discuss available...Full timeContract workPart timeRemote workFlexible hours
- ...reconciliation at each patient encounter by reviewing, verifying, and consolidating all... ..., prescription refill requests, and prior authorizations Care coordination activities as assigned... ...Collaborate with providers, nurses, care managers, and social services to...Full timeWork at officeImmediate startWeekday work
$1,786 per week
...Registered Nurse (RN) | Progressive Care Unit Location: Decatur, GA Agency: Atlas MedStaff Pay: $1,786 per week Shift... ...Great Recruiters. Both of those recognitions are fueled by real reviews by real travel nurses and allied healthcare professionals that...Hourly payFull timeContract workWork at officeRemote workShift workNight shiftWeekend work$1,689 - $1,838 per week
...Registered Nurse (RN) | Progressive Care Unit Location: Atlanta, GA Agency: Host Healthcare Pay: $1,689 to $1,838 per week... ...was rated #1 in Nursing Satisfaction by MIT Sloan Management Review. No matter if you want to explore the other side of the country...Full timeContract workLocal areaImmediate startShift workNight shift$1,651 per week
...Registered Nurse (RN) | Progressive Care Unit Location: Atlanta, GA Agency: Atlas MedStaff Pay: $1,651 per week Shift... ...Great Recruiters. Both of those recognitions are fueled by real reviews by real travel nurses and allied healthcare professionals that...Hourly payFull timeContract workWork at officeRemote workShift workNight shiftWeekend work$1,999 - $2,149 per week
...Registered Nurse (RN) | Progressive Care Unit Location: Atlanta, GA Agency: Host Healthcare Pay: $1,999 to $2,149 per week... ...was rated #1 in Nursing Satisfaction by MIT Sloan Management Review. No matter if you want to explore the other side of the country...Full timeContract workLocal areaImmediate startShift workNight shift- ...A large health care organization in Atlanta is seeking a clinical nurse to perform medical necessity reviews for Home Care and DME services. The ideal candidate will have a B.S. in Nursing and at least three years of clinical nursing experience. Responsibilities include...
- ...client demographic information for registration purposes. Review documentation to determine eligibility for federal and state... ...and responsibilities for program participation. Obtain prior authorization per guidance before releasing medical information. Assist...Full timeWork at officeLocal areaFlexible hours
$100k - $140k
Jobot is seeking a dynamic Permanent Associate Attorney specializing in medical malpractice defense in Atlanta, Georgia. In this hybrid role, you will manage a diverse caseload from start to finish, collaborating closely with partners on case strategy. The successful candidate...Permanent employment$142.71k - $215.44k
...The successful candidate will conduct detailed electrical analyses, perform complex calculations, and collaborate with teams. With a hybrid work schedule, this role offers competitive compensation ranging from $142,710.00 to $215,440.00 and comprehensive benefits...- ...procedures. The role entails managing claims, improving collections, and ensuring compliance with healthcare regulations. The position offers competitive salary, benefits, and a flexible hybrid schedule after 90 days of employment. #J-18808-Ljbffr Firstpro Recruitment, LLCFlexible hours
$50k
...commercial insurance carriers, Medicare, Medicaid, and other payers regarding unpaid, denied... ...maintaining excellent customer service. Review Explanation of Benefits (EOBs) and... ...and holidays Opportunity for a flexible hybrid schedule (4 days in office) after 90 days...Private practiceWork at officeFlexible hours- Kaiser Permanente is seeking a Registered Nurse for the Specialty Care Review team based in Atlanta, Georgia. This role involves performing medical necessity reviews for home health and DME services, requiring a minimum of three years of nursing experience and a current...Relief
- UnitedHealthcare is seeking a Registered Nurse Clinical Annotator to support the development of AI models for prior authorization in healthcare. You will interpret, annotate, and... ..., contextually relevant, and compliant with UM guidelines. Work is remote within the U.S.,...Remote jobFlexible hours
- ...prospective patients. Ensures completion of appropriate clinical review of all applicable patients as stated in system utilization... ...preferred Preferred Qualifications ~ Bachelor of Science in Nursing ~ Previous experience with MCG and/or InterQual systems ~2...ReliefRemote workWeekend work3 days per week
- ...UnitedHealthcare division seeks a Registered Nurse Clinical Annotator to support AI model training for prior authorization processes. The role leverages clinical expertise... ...with responsibilities spanning medical record review, guideline-based annotation, and collaboration...Remote job
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