Review Nurse-PA/UM
Hybrid · Atlanta, Georgia, United States
Job Summary
Hybrid Review Nurse on PA/UM team conducts prior approval and precertification reviews for Georgia Fee-for-Service Medicaid members, evaluates initial clinical information and approves cases that meet criteria using InterQual criteria or nursing judgment, refers cases that do not meet criteria to a Referral Nurse Coordinator for peer review, collaborates with Manager/Supervisor PA/UM and Medical Directors, participates in quality improvement and peer review activities, maintains HIPAA confidentiality, and travels as needed. Requires knowledge of ICD-10-CM, CPT codes, InterQual criteria, strong organizational and interpersonal skills, independence in problem solving, computer literacy, and ability to travel to locations as needed. Location: Atlanta, GA; Hybrid work arrangement.
Required Qualifications
- Registered Nurse, with at least three years of recent clinical experience required
- Current and unencumbered Georgia nursing license required
- Utilization Review or Prior Approval Precertification experience (preferred)
Apply with one swipe on Sorce. We auto-fill applications and apply on your behalf — no cover letters, no 40-minute forms.
Hiring someone like this?
Get your role in front of qualified candidates on Sorce.