- Perform reviews of provider prior approval/precertification requests as per PAUM policy and procedures
- Evaluate initial clinical information and approve cases that meet criteria. 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
- Promote core values of team work, professionalism, effective communication skills and positive attitude
- 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
- Perform other duties as assigned
- Working knowledge of ICD-10-CM, CPT codes, and InterQual criteria preferred.
- Strong theoretical clinical knowledge base and problem-solving skills.
- Strong organizational skills with ability to demonstrate the work priorities.
- Excellent interpersonal, written, and verbal skills required.
- Demonstrates 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. Typing skills at 30-50 WMP and data entry skills required.
- Ability to travel by car or plane to Company locations, customer meetings or other locations as needed.
- Registered Nurse, with at least three (3) years of recent clinical experience required
- Current and unencumbered Georgia nursing license required
- Utilization Review or Prior Approval Precertification experience preferred
-
Review Nurse
3 weeks ago
Alliant Health Solutions, Inc. Atlanta, United StatesJob Description · Job DescriptionAlliant Health Group is a family of companies that provides professional services supporting the effective administration of healthcare programs and funding to support healthcare improvement initiatives. Alliant Health Solutions provides Federal a ...
-
NP or PA, Neurosurgical Oncology, Clinic
1 day ago
Emory Atlanta, United StatesOur Nurse Practitioners and Physician Assistants are an integral part of the Emory Healthcare integrated academic health care system. Some highlights of joining the Emory Healthcare team: · Salary range: $110,000 to $140,000 per year depending upon years of experience as a Nurse ...
-
NP or PA, Neurosurgical Oncology, Emory Clinic
3 weeks ago
Emory Healthcare Atlanta, Georgia, United States PermanentOverview: · Our Nurse Practitioners and Physician Assistants are an integral part of the Emory Healthcare integrated academic health care system. Some highlights of joining the Emory Healthcare team: · Salary range: $110,000 to $140,000 per year depending upon years of experience ...
-
Nurse Practitioner/Sub-Investigator
5 days ago
EmVenio Research Atlanta, United StatesJob Description · Job DescriptionABOUT EMVENIO RESEARCH: · EmVenio Research delivers localized trial access to diverse and underserved communities. We empower patients and embrace communities on their terms. Our research solutions cultivate a sustainable local ecosystem that bene ...
-
Physician Assistant Faculty
1 week ago
South College Atlanta, United States· South College invites capable, energetic, outgoing, applicants who are focused on transforming lives of our customers/students At South College, you will help implement our strategy of "Where Dreams Find Direction" We are one of the nation's fastest growing institutions of hig ...
-
Physician Assistant Faculty
1 day ago
SOUTH COLLEGE Atlanta, United StatesSouth College invites capable, energetic, outgoing, applicants who are focused on transforming lives of our customers/students At South College, you will help implement our strategy of "Where Dreams Find Direction" We are one of the nation's fastest growing institutions of higher ...
-
Physician Assistant Studies
1 week ago
SOUTH COLLEGE Atlanta, United States Full timeJob Description · Job DescriptionDescription:South College invites capable, energetic, outgoing, applicants who are focused on transforming lives of our customers/students At South College, you will help implement our strategy of "Where Dreams Find Direction" We are one of the na ...
-
VAERS Clinician
1 day ago
Lukos LLC Atlanta, United StatesVAERS Physician · Minimum Qualifications Summary · Certification & Education Clinical background (e.g. physician, physician assistant, nurse practitioner); do not need to be a licensed MD. · Experience RequiredPrior experience with medical abstraction · Knowledge of, and experien ...
-
Physician Assistant Faculty
2 days ago
SOUTH COLLEGE Atlanta, United StatesJob Description · Job DescriptionDescription:South College invites capable, energetic, outgoing, applicants who are focused on transforming lives of our customers/students At South College, you will help implement our strategy of "Where Dreams Find Direction" We are one of the na ...
-
registered nurse
2 weeks ago
All Ways Caring HomeCare Atlanta, United StatesOur Company: · All Ways Caring HomeCare · Overview: · Join a team of passionate and caring clinicians who make a difference in people's lives. Our nursing group focuses on compassion and meeting the needs of our clients in a variety of settings. If your passion is outstanding pat ...
-
Unit Chrg RN
1 week ago
Emory Healthcare Atlanta, United StatesOverview · Are you eager to be a part of a nationally acclaimed neurology and neurosurgical team? Join us in the Neurosciences ICU where you'll hone your skills working with ICP monitors, arterial lines, central lines, ventilators, tracheostomies, gastrostomy tubes, CRRT, VAD, te ...
-
RN, Med/Surg-WEO
1 week ago
Emory Healthcare Atlanta, United StatesOverview · Are you interested in elevating your nursing career and joining the forefront of medical innovation? The 5G Complex Medicine unit is the pinnacle of excellence and a beacon of cutting-edge healthcare. On Unit 5G, you will be working with insulin drips, Heparin drips, b ...
-
Emory Atlanta, United States8E Pulmonary/Thoracic/Vascular Surgery is an Intermediate / Progressive Care Unit (PCU) that was awarded a Silver Beacon Award for providing excellence nursing care to patients · The only Lung Transplant Center in the state of Georgia · The only unit with staff trained to care f ...
-
RN, Med/Surg-WEO
1 week ago
Emory Healthcare Atlanta, United StatesOverview · 6G is a well-established 24 beds Medical unit which treats patients with layered and complex medical needs, including autoimmune cases, thyroid cancer, renal, sepsis, and cystic fibrosis. · Best training environment with a one of high case mix index. 6G is 1 of 2 units ...
-
PACU RN, EUH, 10a-10:30p
1 week ago
Emory Healthcare Atlanta, United StatesOverview · Emory University Hospital's PACU is a fast-paced, fun and challenging environment that encourages you to use your critical thinking skills. Our unit offers a work-life balance, self-scheduling, has a family feel with a sense of community and is where we are defining a ...
-
RN, SurgOnc/GYN/Uro
1 week ago
Emory Healthcare Atlanta, United StatesOverview · Heart. Soul. Expertise. That's what defines an Emory nurse. No matter where you are in your nursing career, when you chose this distinguished profession, you chose to change lives. We are proud to be the only health system in Georgia with four Magnet-recognized hospita ...
-
Emory Atlanta, United States8E Pulmonary/Thoracic/Vascular Surgery is an Intermediate / Progressive Care Unit (PCU) that was awarded a Silver Beacon Award for providing excellence nursing care to patients · The only Lung Transplant Center in the state of Georgia · The only unit with staff trained to care f ...
-
RN - Neuro ICU - FT - WEO - 7a-7:30p
1 week ago
Emory Healthcare Atlanta, United StatesOverview · Are you eager to be a part of a nationally acclaimed neurology and neurosurgical team? Join us in the Neurosciences ICU where you'll hone your skills working with ICP monitors, arterial lines, central lines, ventilators, tracheostomies, gastrostomy tubes, CRRT, VAD, te ...
-
Emory Healthcare Atlanta, United StatesOverview · 8E Pulmonary/Thoracic/Vascular Surgery is an Intermediate / Progressive Care Unit (PCU) that was awarded a Silver Beacon Award for providing excellence nursing care to patients · * The only Lung Transplant Center in the state of Georgia · * The only unit with staff tra ...
-
Emory Healthcare Atlanta, Georgia, United States Permanent: · JOB DESCRIPTION: · • Capable clinician who has acquired broad experience in caring for patients, and has developed a sound understanding about the care of a particular patient population. · • Routinely uses acquired knowledge, theory, research and experience to respond to cha ...
Review Nurse-PA/UM - Atlanta, United States - Alliant Health Solutions, Inc.
1 month ago
Description
Job Description
Job DescriptionAlliant Health Group is a family of companies that provides professional services supporting the effective administration of healthcare programs and funding to support healthcare improvement initiatives. Alliant Health Solutions provides Federal and state government entities with the services, expertise and information systems necessary to increase the effectiveness, accessibility and value of health care. The Company has been named a "Best Place to Work" since 2018 and a 2022 "Healthiest Workplace" by the Atlanta Business Chronicle.
This position is remote in the Atlanta, GA metro area upon completion of training and offers work/life balance and excellent benefits.
Currently, we are seeking a Review Nurse to conduct 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:
In this role, the ideal candidate will:
Other Job Functions:
Knowledge, skills and abilities required for this role include:
Education, experience and training required and preferred for the position are below:
Required:
Preferred:
Alliant offers work/life balance and great benefits including medical, dental life, disability, paid-time off, retirement with match and contribution, disability, employee assistance program, parental life, and more. If interested, click the apply icon above to apply.
Alliant Health Group ("the Company) is an Affirmative Action, 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. Please contact
