Top 10 Clinical documentation & utilization review nurses Jobs in Macon, Ga

Utilization Mgmt Coord - Behavioral Health, PRN, Macon
Piedmont Healthcare Inc. —Macon, GA
- PRN
- LMFT
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Health Plan Medical Director
TotalMed, Inc. —Georgia
- $125 an hour
- Part-time
- Remote
- Senior level
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6d
RAI Specialist for Skilled Nursing Services
Community Health Services of Georgia —Gray, GA
- Full-time
- Skilled nursing facility
- Microsoft Outlook
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Registered Nurse
A Daughter's Love Private Home Care, LLC —Macon, GA
- Part-time
- Mid-level
- Home health
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RN - MDS Director
STG International, Inc. —Macon, GA
- Weekends as needed
- Nursing
- RN License
- Office
- Health insurance
- Dental insurance
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RN Supervisor
Primecare Home Care —Warner Robins, GA
- Full-time
- Current TB test
- RN License
- BLS Certification
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Utilization Mgmt Coord - Behavioral Health, PRN, Macon

Piedmont Healthcare Inc. -
Macon, GA

Apply Now

Job Details

Qualifications

Pre-authorization review for utilization management

Full Job Description

Overview: The purpose of this position is to ensure that admitted patients have the appropriate level of care, patient status, authorization status, plan of care and meet medical necessity for the behavioral health services. This role monitors that the patient is progressing in their plan of care and meet medical necessity for continued stay. This role ensure that patient's payor has the clinical information with which to authorize the behavioral health service and continued stay service to include covered days and associated services. Responsibilities:

The purpose of this position is to ensure that admitted patients have the appropriate level of care, patient status, authorization status, plan of care and meet medical necessity for the behavioral health services. This role monitors that the patient is progressing in their plan of care and meet medical necessity for continued stay. This role ensure that patient's payor has the clinical information with which to authorize the behavioral health service and continued stay service to include covered days and associated services.

**ALL PRN'S MUST BE AVAILABLE FOR 6 SHIFTS PER MONTH (3 WEEKDAY SHIFTS AND 3 WEEKEND SHIFTS). DAY SHIFTS ONLY. MUST WORK 1 HOLIDAY IN SPRING/SUMMER AND 1 HOLIDAY IN FALL/WINTER**

Qualifications: Education

Bachelor’s Degree from an accredited nursing school, B.A/ B.S or Required or
Bachelor’s Degree in Social Work Required or
Master’s degree Preferred

Work Experience

2 years of experience in an acute, post-acute, managed care, psychiatric, or revenue cycle Required
Previous experience with InterQual and/or MCG guidelines Required
Previous experience in Utilization Management and/or Appeals Required
Previous Epic experience or Meditech/MIDAS experience Required
Previous experience in prior authorization process Required
Utilization Review or Care Management experience Preferred

Licenses and Certifications

Current unrestricted registered nurse (RN) license or LMSW/LCSW, in the state of Georgia. Required or
LPC/LMFT also acceptable Required

Additional Licenses and Certifications

Case Management Certification (CCM) or American Case Management Association (ACMA) certification Preferred

Business Unit : Company Name: Piedmont Healthcare Corporate

Apply Now

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clinical documentation & utilization review nurses jobs in macon, ga

Utilization Mgmt Coord - Behavioral Health, PRN, Macon

Health Plan Medical Director

RAI Specialist for Skilled Nursing Services

Registered Nurse

RN - MDS Director

RN Supervisor

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