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Full-time
professional certificate
Medical Insurance, Dental Insurance, Life Insurance, Disability Insurance, Paid-time Off, Retirement With Match And Contribution
Posted 23d ago
~40 hrs/week
Responsibilities
The Review Nurse conducts prior approval and precertification reviews for Georgia Fee-for-Service Medicaid members. Responsibilities include evaluating clinical information, documenting review decisions, and collaborating with medical directors for peer reviews.
Requirements
Requires a Registered Nurse license in Georgia with at least three years of recent clinical experience. Experience in Utilization Review or Prior Approval Precertification is preferred.
Full job description
Are you a bedside nurse seeking a change from the hospital setting? If you answered "yes", Alliant Health Solutions, a "2025 Best Place to Work and Healthiest Employer", may be the place for you!
Alliant is recruiting a Hybrid Review Nurse for its Prior Authorization and Utilization Management (PA/UM) team. 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 position, 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 position 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 knows that people thrive when they feel supported, so we offer work/life balance, competitive benefits including medical, dental life, disability, paid-time off, retirement with match and contribution, disability, employee assistance program, parental leave, and other well-being resources. 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.
Health care consultants working with public and private partners to make health care better
Industry
Hospitals and Health Care
Company size
201-500 employees
Founded
1970
Headquarters
Atlanta, Georgia
LinkedIn followers
2,467
Alliant Health Solutions is a nonprofit organization driven to make health care better in the United States by improving quality of care, increasing the value of health care, and promoting prevention and treatment for chronic illnesses.
Our family of companies provide professional services to state, federal and private partners, supporting the effective administration of health care programs and improvement initiatives. Alliant has three primary lines of service offerings that leverage evidenced-based methods, data and technology, and clinical expertise:
• Quality Improvement: making health care safer and more effective
• Utilization Management: ensuring the right care, in the right setting for the right duration
• Program Integrity: ensuring compliance and reducing improper payment, fraud, waste and abuse
Offices: 400 Perimeter Center Terrace NE, Ste. 250, Atlanta, Georgia 30346, US
Based on 809 listings with disclosed salaries, most administrative jobs in Georgia pay between $48k–$95k per year. Individual offers vary with seniority, company size, and specialization.
How many Administrative jobs are open in Georgia right now?
There are currently 7,979 open administrative positions in Georgia listed on Clera. New openings are added daily as companies post roles.
Which companies are hiring for Administrative roles in Georgia?
Companies currently hiring include Northside Hospital, Emory Healthcare, PruittHealth, Emory University Department of Economics, Piedmont HealthCare, among others. Browse the listings above to see every active employer.
Are there remote or hybrid Administrative jobs in Georgia?
Yes — 1080 of the 7979 open administrative positions offer remote or hybrid work (399 remote, 681 hybrid).
How do I apply for Administrative jobs in Georgia?
Each listing links directly to the employer's application page. Apply early — fresh listings get the most recruiter attention in the first two weeks.