Physician’s Nurse - Full time

Review Nurse-PA/UM
If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process.

Regular Full-Time Professionals Atlanta, GA, US

Are you a bedside nurse seeking a change from the hospital setting? If you answered "yes", Alliant Health Solutions, a "2025 Best Place to Work and Healthiest Employer", may be the place for you!

Alliant is recruiting a Hybrid Review Nurse for its Prior Authorization and Utilization Management (PA/UM) team. The Review Nurse conducts prior approval and precertification reviews for Georgia Fee-for-Service Medicaid members for the team’s defined review types while meeting and exceeding contract expectations. The primary responsibilities of the Nurse Reviewers are listed below.

Perform reviews of provider prior approval/precertification requests as per PAUM policy and procedures

Document clearly the rationale for all review decisions using appropriate criteria or nursing judgment

Refer cases that do not meet criteria and cannot be approved by InterQual criteria or nursing judgment to a Referral Nurse Coordinator who in turn assures review by a Peer Review Consultant on any case which a nurse cannot approve

Consult with the Manager, Supervisor PA/UM, or Medical Directors on issues related to Peer Consultant review decisions or cases requiring physician clarification

Participate in quality improvement and peer review activities

Maintain confidentiality of review information and medical records in accordance with HIPAA compliance, and Alliant Policy

Work in close collaboration with other team members to support the development of new projects and continuous improvement of the overall work process within the team

Maintain security and confidentiality of all information in accordance with HIPAA laws, URAC regulations, and company policies

Demonstrate compliance with the corporate and departmental policies as evidenced by attendance, punctuality, and dress

Knowledge of ICD-10-CM, CPT codes, and InterQual criteria preferred

Knowledge, skill and ability to perform work with considerable independence by use of creative thinking, thorough analysis of problems, and use of innovative approaches to problem resolution

Computer literate, experience with MS Windows products

Ability to travel by car or plane to Company locations, customer meetings or other locations as needed

Education, experience and training required and preferred for the position are below:
Registered Nurse, with at least three years of recent clinical experience required

Current and unencumbered Georgia nursing license required

Alliant knows that people thrive when they feel supported, so we offer work/life balance, competitive benefits including medical, dental life, disability, paid-time off, retirement with match and contribution, disability, employee assistance program, parental leave, and other well-being resources. Alliant Health Group and subsidiaries, dba Alliant Health Solutions ("the Company") is an Equal Opportunity Employer and Drug Free Workplace. In compliance with the American's with Disability Act (ADA) and Amendments Act (ADAAA), all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender, gender identity, national origin, disability or veteran status. If you are an individual with a disability and require a reasonable accommodation to complete any part of the application process, please let us know. Likewise, if you are limited in the ability to access or use this online application process and need an alternative method for applying, we will determine an alternative method for you to apply. J-18808-Ljbffr Alliant-Health-Solutions-1