Similar Jobs
See allRemote RN Case Manager
Guidehealth
US
Registered Nurse
Care Management
Motivational Interviewing
Manager, Complex Clinical Review
Machinify
US
Nursing
Project Management
Microsoft Excel
Utilization Management Registered Nurse (RN)
Guidehealth
US
Registered Nurse
Utilization Review
Managed Care
Utilization Review Nurse
Oscar Health
United States
Registered Nurse
Utilization Review
Clinical Practice
Utilization Workflow Manager
Graham Healthcare Group
USA
Coding
Quality Assurance
Key Responsibilities:
- Oversee system-level matrix oversight of utilization management activities.
- Ensure use of medical necessity criteria (InterQual and/or Milliman).
- Manage professional staff with at least two years of management experience.
Qualifications:
- Graduate from a recognized, accredited school of nursing.
- 5 years of acute hospital utilization management experience.
- Current Georgia RN licensure and IQCI certification required.
Work Environment:
- Full-time remote position based in Atlanta, GA.
- Part of a corporate team supporting multiple facilities.
- Focus on quality and compliance in healthcare utilization.
Piedmont Healthcare Corporate
Piedmont Healthcare is a healthcare system providing comprehensive medical services. It is a large organization focused on utilization management and quality care.