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Ability to read, write and speak English language, optimize the use of technology to support clinical care and holds basic computer skills; Strong interpersonal, collaborative skills along with customer service skills required; Ability to function in a fast paced environment and respond to emergencies in using a decisive, composed and respectful manner; Possess excellent time management skills; practices nursing using evidence and analytical skills along with possessing strong critical thinking skills. Exemplary Practice and Outcomes * A.Performs the Nursing Process (assessment; diagnosis; identification of outcomes; planning; implementation and evaluation) in the performance of clinical care using evidence base practice, uses analytical/critical thinking and ensuring that care is individualized; coordinating care through effective partnerships recognizing that caring is central to achieve optimal patient care outcomes * B.Provides relationship-based patient centered care that is consistent with population specific characteristics (e.g.

<p>As the largest healthcare system in the suburbs of Atlanta, WellStar serves more than a million patients a year within our hospitals, health parks, urgent care centers, and medical practices in NW Atlanta. We are a leading not-for-profit health system with state-of-the-art medical technology and a world-class employee family. Onsite concierge services, pension plans and job sharing are just the start of our innovative vision of a ‘Work Life Well Lived!’</p>

Wellstar Health Systems, Inc.

ED RN 7p-7a Full Time

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Will consider years of experience in case management in lieu of Masters degree Required andMinimum 3 years experience in the management of a multidisciplinary staff in the field of case management Required andMinimum 3 years experience in a hospital environment required Required Required Minimum Skills: Maintains FTE, salary and expense budgets at or below budgeted levels, demonstrating the ability to review/analyze current/historical data relevant to budget variances.* Assists with the development of collaborative approaches that promote quality, cost-effective utilization services across the continuum.

UM Manager-Onsite

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A.Performs the Nursing Process (assessment; diagnosis; identification of outcomes; planning; implementation and evaluation) in the performance of clinical care using evidence base practice, uses analytical/critical thinking and ensuring that care is individualized; coordinating care through effective partnerships recognizing that caring is central to achieve optimal patient care outcomes. * C.Participates and supports performance improvement inclusive of all stakeholders, research and research utilization to promote safe, quality patient care including initiating and/or leading such activities as well as, promoting an inter/intra-disciplinary process and actively supports/participates in shared governance at all levels in the system.

Registered Nurse (RN) - Weekend Premier Differential - Emergency Department

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The role contributes to the establishment and maintenance of practices that ensure excellence in patient care, provides for the efficient use of resources, and undertakes leadership task such as staff schedules, unit patient flow, subject matter expertise for clinical concerns, physician rounding, committee involvement, survey readiness, and other task as assigned by the manager, which are basic to the department's ability to function in a smooth and effective manner. Provides or provides oversight for relationship based care delivery patient-centered care by partnering with the patient and significant others (as appropriate) using comprehensive hand-off communication processes; interdisciplinary evaluation and communication (i.e., unit rounds, case reviews, peer review, etc.); just in time and planned patient teaching; keeping the patient informed using appropriate communication tools and making the patients goals the focus of the plan of care.*

Registered Nurse (RN) Charge Med Surg - Days

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How you will make an impact: Utilizes nursing judgment and reasoning to analyze members' clinical information, interface with healthcare providers, make assessments based on clinical presentation, and apply clinical guidelines and/or policies to evaluate medical necessity. The Medical Management Nurse is responsible for review of the most complex or challenging cases that require nursing judgment, critical thinking, and holistic assessment of member's clinical presentation to determine whether to approve requested service(s) as medically necessary.

Elevance Health Inc

Medical Management Nurse - AmeriBen

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How you will make an impact: Utilizes nursing judgment and reasoning to analyze members' clinical information, interface with healthcare providers, make assessments based on clinical presentation, and apply clinical guidelines and/or policies to evaluate medical necessity. Nurse is responsible for review of the most complex or challenging cases that require nursing judgment, critical thinking, and holistic assessment of member's clinical presentation to determine whether to approve requested service(s) as medically necessary.

Medical Management Nurse

Collaborates effectively with the utilization review nurse, patient's physicians and the interdisciplinary care team to provide a comprehensive assessment of the patient's medical care needs, psychosocial needs, any social determinants of health needs, goals/outcome attainment and continued care needs. Specific functions within this role include: Psychosocial and functional status assessment, transitional care planning, clinical care progression, facilitate patient/family care conferences, participate in interdisciplinary rounds, and patient/family education.

WellStar Health System Inc

Care Coordinator RN (Weekdays M-F) @Cobb hospital

Specific functions within this role include: Psychosocial and functional status assessment, transitional care planning, clinical care progression, facilitate patient/family care conferences, participate in interdisciplinary rounds, and patient/family education Collaborates effectively with the utilization review nurse, patient''s physicians and the interdisciplinary care team to provide a comprehensive assessment of the patient''s medical care needs, psychosocial needs, any social determinants of health needs, goals/outcome attainment and continued care needs Assures that the patient is progressing towards their discharge goal and assists to alleviate barriers Seeks consultation from appropriate disciplines/departments as required to proactively identify and resolve delays to expedite care and facilitate discharge. Core Responsibilities and Essential Functions: Assessment Based on preliminary screening of patients, initiates assessment of patients chronic disease management needs and psychosocial risk factors and availability of resources to assist upon discharge.

Registered Nurse (RN) Care Coordinator - FT/Day - Augusta

Care Coordinator RN Kennestone Hospital

RN Care Coordinator - Emergency Dept - Weekend/7a-7p - Augusta

Registered Nurse (RN) Care Coordinator

Care Coordinator RN

Registered Nurse (RN) Care Coordinator PRN

Registered Nurse (RN) - Care Coordinator - Full-Time Day Shift

Care Coordinator - Registered Nurse (RN)

If this job is assigned to any Government Business Division entity, the applicant and incumbent fall under a `sensitive position' work designation and may be subject to additional requirements beyond those associates outside Government Business Divisions. This position is part of our Wellpoint Federal division which, per CMS TDL 190275, requires foreign national applicants meet the residency requirement of living in the United States at least three of the past five years.

Clinical Review Nurse I (US)

EDUCATIONAssociate's Degree in Nursing (Required)Bachelor's Degree in Nursing (Preferred)EXPERIENCE3+ Recent and relevant acute clinical care experience (Required)1+ Utilization review experience in a hospital, managed care or physician office practice setting (Required)CERTIFICATIONS/LICENSURESRegistered Nurse (RN) in the state of Georgia (Required)Certified Case Manager (Preferred)Certified Professional Utilization Review (Preferred)ESSENTIAL FUNCTIONSUTILIZATION REVIEW -RN: Completes utilization review functions on assigned caseload or area and serves as a resource for CM staff, physicians and other staff. Timely communication of clinical information and updates will be provided to the insurance companies as requested or required by contract or federal and state regulations in support of medical necessity justification and hospital billing and payment for patient care and services rendered.

Phoebe Putney Health System

UR Specialist, Care Command RN

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Ensures timely and accurate documentation of clinical reviews and insurance updates as required by payor including authorized days and denied days with reason for denial Works post-discharge/prebill accounts efficiently and effectively daily, to resolve accounts with no auth numbers, ALOS vs. Job Summary: The Utilization Management (UM) Nurse is responsible for conducting medical necessity reviews up to 12 hours per day, on any of the 7 days per week, utilizing Indicia for Case Management, and performs clinical reviews through document review, discussion with physicians and collaboration with the care team on the coordination of safe transitions of care for a defined patient population.

UM Nurse (RN)

Ensures timely and accurate documentation of clinical reviews and insurance updates as required by payor including authorized days and denied days with reason for denial Works post-discharge/prebill accounts efficiently and effectively daily, to resolve accounts with no auth numbers, ALOS vs. BLS - Basic Life Support or BLS-I - Basic Life Support - Instructor or ARC-BLS - Amer Red Cross Basic Life Support or BLS-P - Basic Life Support-Provisional (30 Days) within 90 Days.

RN Central UM Onsite

A. Performs the Nursing Process (assessment; diagnosis; identification of outcomes; planning; implementation and evaluation) in the performance of clinical care using evidence base practice, uses analytical/critical thinking and ensuring that care is individualized; coordinating care through effective partnerships recognizing that caring is central to achieve optimal patient care outcomes. Participates and supports performance improvement inclusive of all stakeholders, research and research utilization to promote safe, quality patient care including initiating and/or leading such activities as well as, promoting an inter/intra-disciplinary process and actively supports/participates in shared governance at all levels in the system.

Utilization Management Nurse Jobs in Georgia

ED RN 7p-7a Full Time Wellstar Health Systems, Inc.

UM Manager-Onsite Wellstar Health Systems, Inc.

Registered Nurse (RN) - Weekend Premier Differential - Emergency Department Wellstar Health Systems, Inc.

Registered Nurse (RN) Charge Med Surg - Days Wellstar Health Systems, Inc.

Medical Management Nurse - AmeriBen Elevance Health Inc

Medical Management Nurse Elevance Health Inc

Care Coordinator RN (Weekdays M-F) @Cobb hospital WellStar Health System Inc

Registered Nurse (RN) Care Coordinator - FT/Day - Augusta WellStar Health System Inc

Care Coordinator RN Kennestone Hospital WellStar Health System Inc

RN Care Coordinator - Emergency Dept - Weekend/7a-7p - Augusta WellStar Health System Inc

Registered Nurse (RN) Care Coordinator WellStar Health System Inc

Care Coordinator RN WellStar Health System Inc

Registered Nurse (RN) Care Coordinator PRN WellStar Health System Inc

Registered Nurse (RN) - Care Coordinator - Full-Time Day Shift WellStar Health System Inc

Care Coordinator - Registered Nurse (RN) WellStar Health System Inc

Clinical Review Nurse I (US) Elevance Health Inc

UR Specialist, Care Command RN Phoebe Putney Health System

UM Nurse (RN) WellStar Health System Inc

RN Central UM Onsite WellStar Health System Inc

RN-Cobb-2S Acute Care Neuro Telemetry- Nights Wellstar Health Systems, Inc.

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