Top 27 Utilization review nurse Jobs in Lawrenceville Ga

Utilization/Clinical Review RN -PRN
Children's Healthcare of Atlanta —Brookhaven, GA
- 8 hour shift
- Nursing
- RN License
- Computer literacy
Quick Apply
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
2d
Inpatient Utilization Review Registered Nurse PRN / RN
Emory Healthcare —Atlanta, GA
- PRN
- Nursing
- RN License
- Inpatient
- Wellness program
- Health insurance
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
Utilization Review Specialist
Positive Impact Health Centers INC —Decatur, GA
- Full-time
- LMFT
- Psychiatry
- RN License
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
1d
Travel RN - Case Management/Utilization Review - Utilization Review
American Traveler —Atlanta, GA
- $2,717.25 a week
- Contract
- RN License
- BLS Certification
- Mid-level
- Health insurance
- Dental insurance
Quick Apply
Registered Nurse (RN) Case Manager - Saturday, Sunday
Children's Healthcare of Atlanta —Atlanta, GA
- Part-time
- Nursing
- RN License
- Computer literacy
Quick Apply
Registered Nurse (RN) Case Manager - PRN
Children's Healthcare of Atlanta —Atlanta, GA
- 8 hour shift
- Nursing
- RN License
- Computer literacy
Quick Apply
Nurse Practitioner
Clinica San Felipe —Atlanta, GA
- $115,477.12 - $139,069.22 a year
- Full-time
- Experience working with individuals with developmental disabilities
- Urgent Care
- HIPAA
Quick Apply
11d
Registered Nurse (RN) Case Manager - Fulltime, Parttime, Weekends Only, PRN
Children's Healthcare of Atlanta —Atlanta, GA
- 8 hour shift
- Nursing
- RN License
- Computer literacy
Quick Apply
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 - Sat, Sun, 1 weekday
Children's Healthcare of Atlanta —Atlanta, GA
- Full-time
- Nursing
- RN License
- Computer literacy
Quick Apply
Field Registered Nurse
Avalon Home Health —Suwanee, GA
- $40.72 - $49.04 an hour
- Part-time
- Patient monitoring
- RN License
- Hospital
Quick Apply
Home Health Clinical Manager
Centerwell —Atlanta, GA
- $77,200 - $106,200 a year
- Full-time
- CPR Certification
- Nursing
- RN License
- Paid parental leave
- Paid holidays
Psychiatric Nurse Practitioner (Hybrid)
HIGHTOP HEALTH LLC —Roswell, GA
- $145,000 - $165,000 a year
- Psychiatry
- Clinic experience
- Outpatient experience
- Health insurance
- Dental insurance
Quick Apply
Psychiatric Mental Health Nurse Practitioner
Salient Health and Wellness —Lawrenceville, GA
- From $1 a month
- Temporary
- Hybrid work
- Vital signs
- Psychiatry
- HIPAA
Quick Apply
9d
Home Health RN - Assessments
Avalon Home Health —Atlanta, GA
- $40.72 - $49.04 an hour
- Part-time
- Patient monitoring
- RN License
- Hospital
Quick Apply

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Telephonic Case Manager I
CorVel Corporation —Lawrenceville, GA
URAC recognized Case Management certification (ACM, CCM, CDMS, CMAC, CMC, CRC, CRRN, COHN, COHN-S, RN-BC) required to be obtained within 3 years of hire if no…
$63,739 - $95,264 a year
Quick Apply
2d
Medical Case Manager I
CorVel Corporation —Lawrenceville, GA
A valid driver’s license, reliable transportation, and ability to travel to assigned locations is required. Provides assessment, planning, implementation, and…
$63,739 - $95,264 a year
Quick Apply
1d

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Utilization Review Specialist - Autism
Nationwide Children's Hospital —Columbus, OH
Bachelor’s Degree in Social Work, Psychology, or related field, required. Documents all case reviews and maintains accurate records of all clinical activities…
Registered Nurse Care Coordinator - Fostering Connections Clinic (PFK)
Nationwide Children's Hospital —Columbus, OH
Valid Ohio driver’s license and proof of auto insurance as required by hospital policy. Pediatric certification, Advanced-Continuity of Care Certification (A-…
6d

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Utilization/Clinical Review RN -PRN

Children's Healthcare of Atlanta -
Brookhaven, GA

Quick Apply

Job Details

Part-time

Qualifications

Computer operation
RN License
Windows
Computer skills

Full Job Description

Note: If you are CURRENTLY employed at Children's and/or have an active badge or network access, STOP here. Submit your application via Workday using the Career App (Find Jobs).

Work Shift

Variable

Work Day(s)

Variable

Shift Start Time

6:00 AM

Shift End Time

5:00 PM

Worker Sub-Type

PRN

Children’s is one of the nation’s leading children’s hospitals. No matter the role, every member of our team is an essential part of our mission to make kids better today and healthier tomorrow. We’re committed to putting you first, and that commitment is at the heart of our company culture: People first. Children always. Find your next career opportunity and make a difference doing what you love at Children’s.

Job Description

Participates as a member of a multidisciplinary team in completing pre-screening assessments of prospective patients. Ensures completion of appropriate clinical review of all applicable patients as stated in system utilization management plan. Oversees Clinical Review Specialist as indicated. Maintains necessary documentation and communication with internal and external customers.

This role is PRN and requires (6) 8-hour days per month with 1 day being on the weekend. We'll be open to offering more if possible. Some Holidays are required as well.

Training/Orientation will be 3 days/week (8-hour days) for 8-10 weeks. Onsite Orientation is needed 3-4 days for first week.

This role will be remote BUT regular meetings/trainings require being onsite at the Support Center in Atlanta GA.

Experience

3 years of experience in a healthcare setting; pediatrics preferred

Preferred Qualifications

Bachelor of Science in Nursing
Previous experience with MCG and/or InterQual systems
2 years of experience in hospital or insurance related utilization review highly preferred

Education

Graduation from an accredited school of nursing

Certification Summary

Licensure as a Registered Nurse in the single State of Georgia or Multi-State through the Enhanced Nurse Licensure Compact

Knowledge, Skills, and Abilities

Working knowledge of financial aspects of third-party payors and reimbursement
Effective decision-making/problem-solving skills
Demonstration of creativity in problem-solving
Must possess above-average computer skills
Must be able to successfully pass the Basic Windows Skill Assessment at 80% or higher rating within 30 days of employment

Job Responsibilities

Provides clinical information to insurance companies as needed for completion of pre-certification process as noted in Children's Healthcare of Atlanta utilization management plan.
Evaluates all patients, including critical care, for appropriateness of admission type and setting, utilizing a combination of clinical information, screening criteria, and third-party information within 24 hours or next business day.
Initiates and facilitates physician communications relative to utilization review process when indicated without prompting and follows up to ensure completion, including peer-to-peer reviews, securing admission orders, and reporting quality issues.
Reviews concurrently all inpatients, including critical care, every three days or sooner if payor requests, including information regarding patient's medical condition, intensity of services being utilized, treatment plan, and established review criteria.
Ensures all pertinent information is documented into various systems for utilization review process.
Gathers and reviews relevant medical information and documents utilization review process outcome based on system accepted utilization criteria on the accepted current review forms and in computer systems.
Supports organizational efforts to ensure accurate capture of admission status and level of care using Epic and escalating cases for status change where necessary.
Refers denied cases to appropriate personnel and provides assistance and/or clinical support to aid in appeal process.
Serves as resource to Case Management for facilitation of patients moving to appropriate level of care and notifying when patients no longer meet medical necessity to aid in discharge planning.
Meets productivity (10-12 reviews/day) and quality assurance (95%) standards and demonstrates utilization review proficiency with the successful completion and passing of McKesson Interrater Reliability testing.
Attends all required onsite, telephonic, and mandatory department meetings.
Participates in department activities to help promote utilization review process, aids in denial prevention, and serves as resource to peers and team members.

Children’s Healthcare of Atlanta is an equal opportunity employer committed to providing equal employment opportunities to all qualified applicants and employees without regard to race, color, sex, religion, national origin, citizenship, age, veteran status, disability or any other characteristic covered by applicable law.

Primary Location Address

1575 Northeast Expy NE

Job Family

Nursing-Non Bedside

Quick Apply

Refine Your Search

utilization review nurse jobs in lawrenceville ga

Utilization/Clinical Review RN -PRN

Telephonic Case Manager I

Inpatient Utilization Review Registered Nurse PRN / RN

Clinical Utilization Review Nurse Preceptor / RN

Utilization Review Specialist

Medical Case Manager I

Travel RN - Case Management/Utilization Review - Utilization Review

Registered Nurse (RN) Case Manager - Saturday, Sunday

Registered Nurse (RN) Case Manager - PRN

Nurse Practitioner

Registered Nurse (RN) Case Manager - Fulltime, Parttime, Weekends Only, PRN

RN Case Manager- IKC, Remote

Registered Nurse (RN) Case Manager - Sat, Sun, 1 weekday

Field Registered Nurse

Home Health Clinical Manager

Psychiatric Nurse Practitioner (Hybrid)

Psychiatric Mental Health Nurse Practitioner

Home Health RN - Assessments

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