Review Nurse, Prior Authorization/Utilization Management
Company: Alliant Health Solutions, Inc.
Location: Atlanta
Posted on: February 19, 2026
|
|
|
Job Description:
Job Description Job Description Alliant 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.
Currently, Alliant Health Solutions, a "2025 Best Place to Work and
Healthiest Employer", seeks a Review Nurse. The Review Nurse
conducts 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 : 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 teamwork, professionalism, effective communication
skills and positive behaviors 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 Knowledge, skills and
abilities required for this role include: Knowledge of ICD-10-CM,
CPT codes, and InterQual criteria preferred Knowledge of clinical
theory and problem-solving skills Strong organizational skills with
ability to demonstrate the work priorities Excellent interpersonal,
written, and verbal skills required Knowledge, skill and 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 Ability to type 30-50 words per minute Ability
to travel by car or plane to Company locations, customer meetings
or other locations as needed Education, experience and training
required and preferred for the position are below: Required:
Registered Nurse, with at least three years of recent clinical
experience required Current and unencumbered Georgia nursing
license required Preferred: Utilization Review or Prior Approval
Precertification experience 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 leave, and more. If
interested, click the apply icon above to apply. Alliant Health
Group and subsidiaries, dba Alliant Health Solutions ("the Company)
is an 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 678-527-3000.
Keywords: Alliant Health Solutions, Inc., Atlanta , Review Nurse, Prior Authorization/Utilization Management, Healthcare , Atlanta, Georgia
