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 Alliant Health Group
- Alliant Health Solutions is looking for a Hybrid Review Nurse to join their Prior Authorization and Utilization Management team in Atlanta, GA. You will conduct... ...prior approval and precertification reviews under Medicaid guidelines, focusing on meeting contract...SuggestedContract work
- Review Nurse-PA/UM If you are unable to complete this application due to a disability... ...you! Alliant is recruiting a Hybrid Review Nurse for its Prior Authorization and Utilization Management (PA/UM... ...for Georgia Fee-for-Service Medicaid members for the team’s defined review...SuggestedFull timeContract 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
$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$2,200 - $2,320 per week
...Registered Nurse (RN) | Utilization Review Location: Atlanta, GA Agency: Compunnel Healthcare Pay: $2,200 to $2,320 per week Shift Information: Days - 5 days x 8 hours Contract Duration: 13 Weeks Start Date: ASAP About the Position Certificates...SuggestedFull timeContract workImmediate startShift workWeekend work$71.1k - $97.8k
...Utilization Management Registered Nurse uses clinical nursing skills... ...time frames. (i.e. 10 reviews per day?) You will communicate... ...agency Health Plan or Medicare / Medicaid Experience Call center or triage... ...Information: To ensure Home or Hybrid Home/Office employees' ability...Bi-weekly payFull timeTemporary workApprenticeshipWork at officeRemote workHome office- ...Snapshot The Appeals Nurse examines medical... ...redeterminations are medically reviewed as needed and completed... ...~ Remote and hybrid work options available.... ...Centers for Medicare & Medicaid Services (CMS) contract... ...including fingerprinting prior to being granted access...Contract workFor contractorsImmediate startRemote 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...Full timeRemote workMonday to FridayFlexible hours
$43.5k - $53.5k
...This role involves verifying and documenting applications for Medicaid recipients, providing customer service, and managing cases effectively... ...HIPAA, and strong mathematical skills. The position offers a hybrid work arrangement and a pay range of $43,500.00 - $53,500.00 per...- ...of varying licensure status, Assessors, Paraprofessionals, Nurses & other therapy providers. We are actively growing and... ...assessment documentation, physical assessments/vitals, medication review and prior authorization (PA) form completions. The Nurse also will manage,...Work from homeMonday to Friday
- ...Outpatient services include behavioral health, nursing, and psychiatric assessment,... ...completing patient assistance applications and prior authorizations as needed. Records all care... ...we encourage you to apply. We promptly review all applications. Highly qualified candidates...Full timeTemporary workFlexible hours
$2,645 per week
Job Summary Cross Country Nurses is seeking a travel nurse RN Utilization Review for a travel nursing job in Atlanta, Georgia. The organization is seeking a licensed... ...as MCG, KP, and LCD criteria. The role requires prior utilization management experience, and candidates...Shift workDay shift$90.87 - $154.33 per hour
A healthcare company is seeking a remote Physician Clinical Reviewer with a Doctor of Medicine (MD), Doctor of Osteopathic Medicine (DO), or equivalent degree. Responsibilities include reviewing clinical cases, communicating with physicians, and ensuring compliance with...Remote work- ...management Preferred Qualifications Nursing Professional Development (NPD)... ...transportation initiation (ground & air), prior authorizations, securing durable medical equipment, completing... ...policies and actively participate in review and revision of policies and procedures...Work at officeWeekday work
- ...provider with an array of services: Skilled Nursing, Personal Care Services, Companionship... ...members receiving homecare services. Reviewing referrals, evaluating the member’s skilled... ...visits are not billable through Medicaid. QUALIFICATIONS: A current Georgia RN license...Flexible hours
- ...Compliance Nurse 2 The Georgia Department of Community Health (DCH) is one of Georgia... ...people. DCH serves as the lead agency for Medicaid, oversees the State Health Benefit Plan (... ...and a written survey process to review the quality of nursing care delivered in...Work at office
- ...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
$80 per hour
In‑Person or Hybrid Licensed Therapist (LCSW, LMFT, LPC) - Georgia - Double Pay for New In‑Person Intakes Through 2025! Rula Health... .... Any misuse of this incentive, as determined by Rula, will be reviewed in accordance with the Network Access Agreement and providers may...Hourly payContract workFor contractorsFreelancePrivate practiceWork at officeLocal areaFlexible hours- ...Suite 200, Indianapolis, IN, 46240, US (Hybrid) Essential Functions and Primary Duties... ...and state legislative mandates impacting Medicaid or other health and human services programs... ...CBIZ is an equal opportunity employer and reviews applications for employment without...Contract workWork experience placementInternship
- ...the following: Physicians, Advanced Nurse Practitioners, Physician Assistants and... ...take vital signs if applicable. Prior to surgery, reviews and completes required surgical documents... ...record. Performs medication prior authorizations as necessary. Responsible for...Work at officeRelocation
- ...leadership programs and… more! Description The Registry Utilization Review Nurse (PRN) is responsible for conducting medical necessity... ...appropriately reviewed in order to obtain the appropriate authorization from the payer in an effort to ensure appropriate payment for...Temporary workCasual workReliefShift work
- ...Emory Healthcare in Atlanta is seeking a Registry Utilization Review Nurse (PRN) responsible for conducting medical necessity reviews utilizing Milliman and Interqual guidelines. This role requires effective communication with physicians, patients, and payers to ensure...Relief
$43.5k - $53.5k
...Premium Assistance program information to Medicaid‑eligible individuals and their families... ...cases during open enrollment and premium review periods to support revenue and program growth... .... What you should expect in this role Hybrid work arrangement based in the Tucker, GA...Full timeWork at officeMonday to FridayFlexible hours2 days per week- ...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...
- ...seeking a Clinical Coordinator for its Georgia operations. This hybrid full-time position involves managing patient care coordination,... ...and scheduling. The ideal candidate should be a CMA or licensed nurse with at least one year of healthcare experience. Strong communication...Full time
- Employee Benefits Consultant Location: Atlanta, GA Schedule: Hybrid after 6 months About Acrisure A global fintech leader, Acrisure... ...content. Data Analysis and Reporting: Lead the collection and review of claims reports, renewal data, and vendor documentation. Utilize...Work at officeImmediate startFlexible hours
- ...Care Physician Value-Based Care Hybrid (Atlanta, GA) An... ...interdisciplinary teams, including nurses, social workers, chaplains, and... ...Participate in performance reviews and quality initiatives to meet... ...Medicare Advantage, managed Medicaid, and population health models...Full timeLocal areaRemote workRelocation packageMonday to FridayWeekend work
$1,397 - $1,546 per week
...Registered Nurse (RN) | Progressive Care Unit Location: Atlanta, GA Agency: Host Healthcare Pay: $1,397 to $1,546 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- ...industry, and in people's lives. Overview The RN Clinical Nurse is a proactive member of an interdisciplinary team of licensed... ...communication methods (interdisciplinary rounds, case review, etc); completion of timely documentation and promotion of a respectful...Relocation packageShift work
$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
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