JOB TITLE: Full Time Review Nurse (PA/UM)
REPORTS TO: Pam Boyd
Deputy Director, Medical Management Services
DEPARTMENT: Medicaid
LOCATION: Atlanta
STATUS: Exempt
POSITION SUMMARY:
The Review Nurse (PA/UM) is responsible for the intake data entry, medical review, and appropriate processing of Prior Authorization and Precertification cases. The Review Nurse will process provider telephone and written requests for pre-procedure and emergency medical necessity reviews; evaluate clinical information; approve cases which follow policy and meet criteria; refer or deny all other cases. All nurses participate in quality improvement activities to enhance the services we provide under the Medicaid Contract.
QUALIFICATIONS:
Current Georgia RN License;
Four to five years of recent work experience in clinical/related field: Medical, Surgical, ER, and/or ICU.
Previous Utilization Review, Case Management and/or Quality Assurance experience preferred.
Computer knowledge & data entry skills
Must have strong written and verbal communication skills.
Ability to work with considerable independence by utilizing critical thinking and analytical skills.
Must be self-motivated.
Interested candidates should complete an Application for Posted Position, attach a resume to the application, and submit to Human Resources within the dates listed below:
DATE POSTED: Tuesday, June 7, 2011
DATE CLOSED: Tuesday, June 14, 2011
Mark Clayton
HR Systems/Accounting Specialist
Office - 678.527.3655
Fax - 678/527-3755
Cell - 404.729.5117
mclayton@gmcf.org
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