Top 41 Utilization review nurse Jobs in Decatur Ga

Utilization Review Nurse
Oscar Health —Atlanta, GA
- $35.00 - $45.94 an hour
- Weekends as needed
- Remote
- Nursing
- RN License
- Mid-level
- Paid parental leave
- Paid holidays
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Registered Nurse (RN) Utilization Management - M-F (8a-4:30p) - North Fulton
3410 Wellstar North Fulton Hospital, Inc. —Roswell, GA
- Full-time
- Nursing
- RN License
- Computer literacy
3d
Manager of Clinical Annotation - Remote
UnitedHealthcare —Atlanta, GA
- $91,700 - $163,700 a year
- Full-time
- Remote
- Nursing
- RN License
- 5 years
Utilization/Clinical Review RN -PRN
Children's Healthcare of Atlanta —Brookhaven, GA
- 8 hour shift
- Nursing
- RN License
- Computer literacy
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Utilization Review Specialist
Positive Impact Health Centers INC —Decatur, GA
- Full-time
- LMFT
- Psychiatry
- RN License
Inpatient Utilization Review Registered Nurse PRN / RN
Emory Healthcare —Atlanta, GA
- PRN
- Nursing
- RN License
- Inpatient
- Wellness program
- Health insurance
Telephonic Case Manager I
CorVel Corporation —Lawrenceville, GA
- $63,739 - $95,264 a year
- Full-time
- Remote
- Nursing
- RN License
- Computer literacy
- Health savings account
- Disability insurance
Quick Apply
13d
Clinical Utilization Review Nurse Preceptor / RN
Emory Healthcare —Atlanta, GA
- $49.77 - $57.70 an hour
- Full-time
- Nursing
- RN License
- Bachelor's degree
- Wellness program
- Health insurance
Review Nurse, Pediatric Review
Alliant Health Solutions, Inc. —Atlanta, GA
- Full-time
- Nursing
- RN License
- Computer literacy
Quick Apply
7d
Clinical Care Coordinator
Grady Health System —Atlanta, GA
- Full-time
- Hospital
- Mid-level
- Paid holidays
- Disability insurance
Care Manager - RN
Northside Hospital Inc. —Sandy Springs, GA
- Full-time
- Nursing
- RN License
- Hospital
3d
Patient Support Nurse
Valeris, Inc. —Atlanta, GA
- Full-time
- Background check
- RN License
- Pass drug screening
- Health savings account
- AD&D insurance
Quick Apply
Acute Nurse Case Manager
JenCare, A ChenMed Company —Decatur, GA
- $36.90 - $52.70 an hour
- Full-time
- Hybrid work
- Acute care
- Background check
- Nursing
- Free parking
- Health savings account
4d
Registered Nurse Case Manager
Southern Regional Medical Center —Riverdale, GA
- 8 hour shift
- Acute care
- Nursing
- RN License
Acute Care Nurse
JenCare, A ChenMed Company —Atlanta, GA
- $36.90 - $52.70 an hour
- Full-time
- Hybrid work
- Acute care
- Background check
- Nursing
- Free parking
- Health savings account
3d
Medical Case Manager I
CorVel Corporation —Lawrenceville, GA
- $63,739 - $95,264 a year
- Full-time
- Remote
- Nursing
- RN License
- Computer literacy
- Health savings account
- Disability insurance
Quick Apply
12d
Total Joint Coordinator RN
Resurgens Surgical Center (11505) —Atlanta, GA
- Full-time
- Nursing
- Surgery
- RN License
RN MDS Director
Perimeter Rehabilitation Suites by Harborview —Sandy Springs, GA
- Full-time
- Skilled nursing facility
- RN License
- Senior level
- Disability insurance
- Health insurance
Quick Apply
4d
RN Case Manager- IKC, Remote
DAVITA —Atlanta, GA
- $17.00 - $21.71 an hour
- Full-time
- Hybrid work
- Microsoft Word
- Spanish
- CPR Certification
- Health insurance
- 401(k) matching
Registered Nurse (RN) Case Manager - PRN
Children's Healthcare of Atlanta —Atlanta, GA
- 8 hour shift
- Nursing
- RN License
- Computer literacy
Quick Apply

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utilization review nurse jobs near decatur ga

Utilization Review Nurse

Oscar Health -
Atlanta, GA

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Job Details

$35.00 - $45.94 an hour

Benefits

Paid parental leave
Paid holidays
Disability insurance
Health insurance
Dental insurance
Parental leave
Vision insurance
Paid sick time

Qualifications

Nursing
Utilization review
Managed care organization experience
Acute care facility experience
InterQual
Utilization management
Decision making
Resource utilization in healthcare
Nursing

Full Job Description

Hi, we're Oscar. We're hiring a Utilization Review Nurse to join our Utilization Review team.

About the role:

You will perform frequent case reviews, check medical records and speak with care providers regarding treatment as needed. You will make recommendations regarding the appropriateness of care for identified diagnoses based on the research results for those conditions.

You will report into the Supervisor, Utilization Review.

Work Location: This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; Illinois; Iowa; Kansas; Michigan; Missouri; Nebraska; New Jersey; North Carolina; Ohio; Pennsylvania; South Carolina; Tennessee; Texas; or Virginia. While your daily work will be completed from your home office, occasional travel may be required for team meetings and company events.

Pay Transparency: The base pay for this role is: $35.00 - $45.94 per hour. You are also eligible for employee benefits and monthly vacation accrual at a rate of 15 days per year.

Responsibilities:

Complete medical necessity reviews and level of care reviews for requested services using clinical judgment and Oscar Clinical Guidelines, Milliman Care Guidelines
Obtain the information necessary (via telephone and fax) to assess a member's clinical condition, and apply the appropriate evidence-based guidelines
Meet required decision-making SLAs
Refer members for further care engagement when needed
Compliance with all applicable laws and regulations
Other duties as assigned

Requirements:

Active, unrestricted RN licensure from the United States in [state], OR, active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC)
Associate Degree - Nursing or Graduate of Accredited School of Nursing Or Successful completion of Nursing Diploma Program in Accredited School of Nursing
Ability to obtain additional state licenses to meet business needs
1+ year of utilization review experience in a managed care setting
Strong experience utilizating MCG (Milliman Care Gudielines) or InterQual
1+ years of clinical experience (including at least 1+ year clinical practice in an acute care setting, i.e., ER or hospital)
Weekend availability is required; all applicants must be able to work at least one weekend day (Saturday or Sunday) each week.

Bonus points:

BSN
Previous experience conducting concurrent or inpatient reviews for a managed care plan

This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here.

At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We're on a mission to change health care - an experience made whole by our unique backgrounds and perspectives.

Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements.

Artificial Intelligence (AI): Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts.

Reasonable Accommodation: Oscar applicants are considered solely based on their qualifications, without regard to applicant's disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team ([email protected]) to make the need for an accommodation known.

California Residents: For information about our collection, use, and disclosure of applicants' personal information as well as applicants' rights over their personal information, please see our Privacy Policy.

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Refine Your Search

utilization review nurse jobs in decatur ga

Utilization Review Nurse

Registered Nurse (RN) Utilization Management - M-F (8a-4:30p) - North Fulton

Manager of Clinical Annotation - Remote

Utilization/Clinical Review RN -PRN

Utilization Review Specialist

Inpatient Utilization Review Registered Nurse PRN / RN

Telephonic Case Manager I

Clinical Utilization Review Nurse Preceptor / RN

Review Nurse, Pediatric Review

Clinical Care Coordinator

Care Manager - RN

Patient Support Nurse

Acute Nurse Case Manager

Registered Nurse Case Manager

Acute Care Nurse

Medical Case Manager I

Total Joint Coordinator RN

RN MDS Director

RN Case Manager- IKC, Remote

Registered Nurse (RN) Case Manager - PRN

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