Talent.com
State Licensed Clinical Reviewer
State Licensed Clinical ReviewerVirtualVocations • Atlanta, Georgia, United States
State Licensed Clinical Reviewer

State Licensed Clinical Reviewer

VirtualVocations • Atlanta, Georgia, United States
1 day ago
Job type
  • Full-time
Job description

A company is looking for a Clinical Reviewer to perform Utilization Management and review clinical information for service requests.

Key Responsibilities

Evaluate referral appropriateness for services and determine medical necessity

Request additional clinical information and interact with the Medical Director as needed

Ensure timely case review and maintain knowledge of services and guidelines

Required Qualifications

Associate's Degree or Diploma in Nursing / Practical Nursing

Registered Nurse / LPN / LVN with active licensure in the state(s) of practice

1-2 years prior authorization experience for Medicare or Medicare Advantage Home Health

Minimum of 2 years in a clinical setting

Knowledge of Medicare PDGM and experience with Interqual is desired

Create a job alert for this search

Clinical Reviewer • Atlanta, Georgia, United States

Related jobs
Inpatient DRG Sr. Reviewer

Inpatient DRG Sr. Reviewer

Zelis Healthcare, LLC • Atlanta, GA, United States
Full-time
Zelis is modernizing the healthcare financial experience across payers, providers, and healthcare consumers.We serve more than 750 payers, including the top five national health plans, regional hea...Show more
Last updated: 20 days ago • Promoted
Dialysis Clinical Manager Registered Nurse - RN

Dialysis Clinical Manager Registered Nurse - RN

Fresenius Medical Care • Lithonia, GA, US
Full-time
About this role : As a Clinical Manager with Fresenius Medical Care, you will ensure that quality patient care is delivered while maintaining clinical operations. As the facility leader, you will be ...Show more
Last updated: 20 days ago • Promoted
Clinical Manager, RN - Full Time

Clinical Manager, RN - Full Time

Affinity Hospice • Lawrenceville, GA, US
Full-time
Affinity Hospice is one of the fastest growing, privately held hospice organizations in the country.We are passionate about giving exceptional care to our hospice patients and their families.We bel...Show more
Last updated: 25 days ago • Promoted
RN Resident

RN Resident

WellStar Health System • Experiment, Georgia, US
Full-time +1
OnsitelocationsSpalding Medical Centertime typeFull timeposted onPosted 30+ Days Agojob requisition idJR-31055.How would you like to work in a place where your contributions and ideas are valued? A...Show more
Last updated: 30+ days ago • Promoted
Senior Clinical Solutions Manager- West

Senior Clinical Solutions Manager- West

Becton Dickinson • Covington, GA, US
Full-time
Senior Clinical Solutions Manager.The Senior Clinical Solutions Manager (CSM) role will bridge the gap between the clinical and business aspects of UCC. The role will be a direct people leader for t...Show more
Last updated: 30+ days ago • Promoted
Clinical Supervisor (RN)

Clinical Supervisor (RN)

Georgia Hospice Care • Covington, GA, US
Full-time
Become an RN Clinical Supervisor with Georgia Hospice Care.We are looking for impeccable leaders to join our team who are committed to creating meaningful patient experiences.As a clinical supervis...Show more
Last updated: 7 days ago • Promoted
Travel Clinical Decision Unit RN

Travel Clinical Decision Unit RN

Olaro • Marietta, GA, US
Full-time
Olaro is seeking a travel nurse RN Acute Care for a travel nursing job in Marietta, Georgia.Job Description & Requirements. Pay package is based on 12 hour shifts and 36 hours per week (subject ...Show more
Last updated: 30+ days ago • Promoted
Clinical Supervisor (RN) $15,000 Sign on Bonus!

Clinical Supervisor (RN) $15,000 Sign on Bonus!

Georgia Hospice Care • Lawrenceville, GA, US
Full-time
Become an RN Clinical Supervisor with Georgia Hospice Care.We are looking for impeccable leaders to join our team who are committed to creating meaningful patient experiences.As a clinical supervis...Show more
Last updated: 30+ days ago • Promoted
Travel Clinical Decision Unit RN - $1,922 per week

Travel Clinical Decision Unit RN - $1,922 per week

Olaro • Marietta, GA, US
Full-time
Olaro is seeking a travel nurse RN Acute Care for a travel nursing job in Marietta, Georgia.Job Description & Requirements Specialty : Acute Care Discipline : RN Start Date : ASAP Duration : 13 weeks 3...Show more
Last updated: 21 hours ago • Promoted • New!
Regional Clinical Sales Program Director

Regional Clinical Sales Program Director

Enhabit Home Health & Hospice • Lawrenceville, GA, US
Full-time
Regional Clinical Program Director.Territory : Athens, Lawrenceville, Gainesville and Eatonton, GA.The regional clinical program director will office from one of these home health agency locations a...Show more
Last updated: 30+ days ago • Promoted
Clinical Manager

Clinical Manager

Georgia Hospice Care • Newnan, GA, US
Full-time
Become an RN Clinical Supervisor with Georgia Hospice Care.We are looking for impeccable leaders to join our team who are committed to creating meaningful patient experiences.As a clinical supervis...Show more
Last updated: 2 hours ago • Promoted • New!
Clinical Director

Clinical Director

NANA Healthcare Management, LLC • Dunwoody (ARP), GA, US
Full-time
Quick Apply
Atlanta Recovery Place (ARP) offers personalized aftercare with structure and support for lasting recovery by focusing on mental, physical and emotional healing. What we are looking for in a C...Show more
Last updated: 15 days ago
Clinical Manager (RN)

Clinical Manager (RN)

Georgia Hospice Care • Tucker, GA, US
Full-time
Become an RN Clinical Supervisor with Georgia Hospice Care.We are looking for impeccable leaders to join our team who are committed to creating meaningful patient experiences.As a clinical supervis...Show more
Last updated: 7 days ago • Promoted
RN Resident

RN Resident

Wellstar Health System • Griffin, Georgia, United States
Full-time
How would you like to work in a place where your contributions and ideas are valued? A place where you can serve with compassion, pursue excellence and honor every voice? At Wellstar, our mission i...Show more
Last updated: 4 days ago • Promoted
Clinical Manager - Care Link

Clinical Manager - Care Link

Piedmont Healthcare • Fayetteville, GA, US
Full-time
RESPONSIBLE FOR : Administrative and operational responsibility for assigned departments, including management of cost and finance, human resources, operations, quality of care and clinical outcomes...Show more
Last updated: 6 days ago • Promoted
Clinical Manager - ICU

Clinical Manager - ICU

Piedmont Healthcare • Conyers, GA, US
Full-time
Responsible for : Administrative and operational responsibility for assigned departments, including management of cost and finance, human resources, operations, quality of care and clinical outcomes...Show more
Last updated: 30+ days ago • Promoted
Travel Clinical Decision Unit RN - $1,940 per week

Travel Clinical Decision Unit RN - $1,940 per week

Olaro • Marietta, GA, US
Full-time
Olaro is seeking a travel nurse RN Acute Care for a travel nursing job in Marietta, Georgia.Job Description & Requirements. Pay package is based on 12 hour shifts and 36 hours per week (subject ...Show more
Last updated: 30+ days ago • Promoted
Clinical Manager - Imaging

Clinical Manager - Imaging

Piedmont Healthcare • Cartersville, GA, US
Full-time
Work Hours : Monday - Friday 8 : 30am - 5 : 00pm.Responsible For : Administrative and operational responsibility for assigned departments, including management of cost and finance, human resources, routi...Show more
Last updated: 30+ days ago • Promoted
RN, - Clinical Manager, Cath Lab

RN, - Clinical Manager, Cath Lab

Piedmont Eastside Medical Center • Snellville, GA, United States
Full-time
RN with a minimum of 2 years experience.Must obtain ACLS and Rhythm Recognition Certification within 90 days of hire.Administrative and operational responsibility for assigned departments including...Show more
Last updated: 19 hours ago • Promoted • New!
Assistant Clinical Director (ACD)

Assistant Clinical Director (ACD)

Hopebridge • Snellville, GA, US
Full-time
Quick Apply
The Assistant Clinical Director (ACD) provides clinical oversight of ABA services within a center, supports a caseload, and provides ongoing structured mentorship to BCBAs in the center.The ACD is ...Show more
Last updated: 30+ days ago