the smart solution for Atlanta jobs

Registered Nurse RN - Utilization Management Denials & Appeals

Company: WellStar Health System
Location: Marietta
Posted on: January 15, 2019

Job Description:


At WellStar we all share common goals. That's what makes us so successful - and such an integral part of our communities. We want the same things, for our organization, for our patients, and for our colleagues. As the largest not-for-profit healthcare system in Georgia, this means we pride ourselves on investing in the communities that we serve. We continue to provide innovative care models, focused on improving quality and access to healthcare.


WellStar is looking to add a Registered Nurse (RN), Utilization Management Denials & Appeals to its team!!

The Clinical Appeals Process focuses on the review and analysis of medical necessity and authorization payer denials rationales and provides appropriate medical necessity appeal services. The Appeals Nurse will review all denial rationales and case-specific medical records for compliance, accuracy and completeness in accordance with departmental policies and regulations, medical necessity criteria set, payer regulations and other contractual requirements. The appeal nurse will work in conjunction with the UM medical director in constructing appeal letters as appropriate.


Required Minimum Education:

At least a 2-year degree in nursing required. Bachelor's or above preferred

Required Minimum Certification:

Must possess a current nursing license (RN) in state of GA.

Required Minimum Experience:

Minimum of 3 years of experience as a case manager, discharge planner, utilization review nurse required.
Minimum of three years of experience as a staff nurse in an acute care setting.

Required Minimum Skills:

Proficient in typing
Experience with Microsoft Office suite
Ability to learn and understand various clinical software applications
Strong clinical judgment and multitasking ability
Excellent problem-solving skills
Self-motivation and ability of working independently with limited supervision and structure
Excellent interpersonal, verbal, and written communication skills

Join us for outstanding benefits and development opportunities. We also offer state-of-the-art technology, professional support and advancement, and colleagues that rank amongst the best in the country.

Step up to your potential. Find out more and apply today!

Keywords: WellStar Health System, Atlanta , Registered Nurse RN - Utilization Management Denials & Appeals, Executive , Marietta, Georgia

Click here to apply!

Didn't find what you're looking for? Search again!

I'm looking for
in category

Other Executive Jobs

Sales Manager, eCommerce and Phone
Description: Position Overview The e-Commerce Sales Manager has the opportunity to lead a sales team to create an exceptional experience for customers.-- This role is responsible for selecting, training, coaching, (more...)
Company: AutoNation Inc
Location: Buford
Posted on: 01/21/2019

Claims Manager - Commercial Property
Description: Location: Atlanta, GA Length of Assignment: Direct Hire Compensation: 100,000 to 150,000 Annually, Depending on Experience Job Description:Our client, an AM Best Rated A insurance carrier, is looking (more...)
Company: TheBestIRS, Insurance Recruiting Specialists
Location: Atlanta
Posted on: 01/21/2019

Overnight Front Office Manager
Description: Kimpton Atlanta HotelOur mission is to be the best loved Hotel Restaurant Company so regardless of position, we look for individuals who are passionate about providing genuine heartfelt care to our (more...)
Company: Kimpton Hotels & Restaurants
Location: Atlanta
Posted on: 01/21/2019

Area Sales Manager - All Covered
Description: All Covered, IT Services Division of Konica Minolta Business Solutions KMBS , is the leading national IT services company serving SMB to enterprise markets. Offering a wide variety of career opportunities, (more...)
Company: Konica Minolta
Location: Atlanta
Posted on: 01/21/2019

Medical Case Manager
Description: WHO WE AREJoin the Team - Make A Difference Work at AID Atlanta, an affiliate of AHF. br br AID Atlanta, Inc. has been saving and transforming lives since its inception in 1982. The agency is the (more...)
Company: AIDS Healthcare Foundation
Location: Atlanta
Posted on: 01/21/2019

Chief Operating Officer
Description: COMPANY provides scientific, information management, management consulting, bioinformatics, and administrative program support to the Centers for Disease Control and Prevention CDC and other Federal (more...)
Company: Mgmt Consulting, Atlanta, GA
Location: Atlanta
Posted on: 01/21/2019

Restaurant Shift Manager
Description: McDonald's is now hiring experienced Shift Managers for our locations in Jonesboro, Senoia, and Union City 30 minutes south of the airport . We encourage military members to apply
Company: McDonald's
Location: Jonesboro
Posted on: 01/21/2019

Vice President of Operations
Description: GEODIS is one of the world's largest leading Supply Chain Operators At GEODIS, we create with you an infinite amount of career opportunities. As a GEODIAN, you will work hands on with products from hundreds (more...)
Company: GEODIS
Location: Atlanta
Posted on: 01/21/2019

Senior Project Manager of Clinical Research
Description: Kelly Services is currently hiring a Senior Project Manager of Clinical Research for a DIRECT HIRE position in Atlanta, GA . This is a full-time direct hire role with benefits and relocation (more...)
Company: Kelly Services
Location: Atlanta
Posted on: 01/21/2019

VP National Accounts Specialty Sales
Description: Position Description br br Sales position has overall accountability for the distribution of the Specialty Benefit's products in the national accounts market segment for an assigned local national (more...)
Company: Healthcare/Hospitals/Clinics, Atlanta, GA
Location: Atlanta
Posted on: 01/21/2019

Log In or Create An Account

Get the latest Georgia jobs by following @recnetGA on Twitter!

Atlanta RSS job feeds