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utilization management nurse consultant

CVS Health

<div>At CVS Health, we&rsquo;re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.
As the nation&rsquo;s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues &ndash; caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.
Position Summary
CVS Health Aetna has an opportunity for a full-time Utilization Management (UM) Nurse Consultant. As a Utilization Management Nurse Consultant, you will utilize clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program. You would be responsible for ensuring the member is receiving the appropriate care at the appropriate time and at the appropriate location, while adhering to federal and state regulated turn-around times. This includes reviewing written clinical records.
Key Responsibilities of the UM Nurse Consultant (Includes but is not limited to)<ul><li>
Reviews services to assure medical necessity, applies clinical expertise to assure appropriate benefit utilization, facilitates safe and efficient discharge planning and works closely with facilities and providers to meet the complex needs of the member.</li><li>
Facilitate the delivery of appropriate benefits and/or healthcare information which determines eligibility for benefits while promoting wellness activities.</li><li>
Develops, implements and supports Health Strategies, tactics, policies and programs that ensure the delivery of benefits and to establish overall member wellness and successful and timely return to work.</li><li>
Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members.</li><li>
Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members.</li><li>
Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure, and clinical judgment to render coverage determination/recommendation along the continuum of care.</li><li>
Communicates with providers and other parties to facilitate care/treatment.</li><li>
Identifies members for referral opportunities to integrate with other products, services and/or programs.</li><li>
Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization.</li></ul>
Required Qualifications<ul><li>
Registered Nurse (RN) with current unrestricted US licensure required.</li><li>
2+ years clinical practice experience as an RN required.</li><li>
2+ Years Utilization Management experience.</li><li>
Must be willing to travel to the local office as needed if living within approximately 45 minutes/miles.</li></ul>
Preferred Qualifications<ul><li>
Bilingual proficiency preferred.</li><li>
1+ year(s) experience utilizing multiple computer systems and applications including Microsoft Word, Excel, Outlook, and web-based applications.</li></ul>
Education<ul><li>
Associate&rsquo;s degree in Nursing.</li><li>
BSN preferred.</li></ul>
Anticipated Weekly Hours
40
Time Type
Full time
Pay Range
The typical pay range for this role is:
$26.01 - $74.78
This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. 
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great benefits for great people
We take pride in our comprehensive and competitive mix of pay and benefits &ndash; investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:<ul><li>
Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.</li><li>
No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.</li><li>
Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.</li></ul>
For more information, visit https://jobs.cvshealth.com/us/en/benefits
We anticipate the application window for this opening will close on: 11/07/2025
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.</div>

Utilization Management Nurse Consultant

Northside Hospital

<div>Overview:
<div>
Northside Hospital is award-winning, state-of-the-art, and continually growing. Constantly expanding the quality and reach of our care to our patients and communities creates even more opportunity for the best healthcare professionals in Atlanta and beyond. Discover all the possibilities of a career at Northside today.</div>
Responsibilities:
<div>
The Research Nurse I will be responsible for rendering patient care services to patients on research protocols approved through the Northside Hospital IRB. Responsibilities involve patient registration, data collection, data submission, adverse event reporting, patient follow-up, records management, protocol regulatory management, quality assurance and other activities related to research. Major roles of the Research Nurse include those of practitioner, researcher, educator and consultant. The Research Nurse is a professional person with knowledge, skills and abilities in the following areas: specific disease management nursing, data management, physical assessment skills, leadership ability and communication skills.</div>
Qualifications:

REQUIRED<ul><li>
Graduate of an accredited school of nursing with a Bachelor or Associate degree and current and unencumbered licensure as a Registered Nurse in the State of Georgia
</li><li>One (1) year relevant work experience in a clinical setting
</li><li>Current and valid American Heart Association Basic Life Support (BLS) Provider CPR &amp; AED Program card</li><li>
If not Certified Clinical Research Coordinator (CCRC) or a Certified Clinical Research Professional (CCRP) at time of hire, must achieve professional certification through the Association of Clinical Research Professionals (ACRP) or the Society of Clinical Research Associates (SOCRA) within three (3) years of hire.</li><li>
If not certified at time of hire, must obtain within three (3) years of hire, one (1) of the following:<ul><li>
FOR ONCOLOGY: Oncology Certified Nurse (OCN) through the Oncology Nursing Certification Corporation (ONCC)</li><li>
FOR BMT: Blood &amp; Marrow Transplant Certified Nurse (BMTCN) through Oncology Nursing Certification Corporation (ONCC)</li></ul></li></ul>
PREFERRED<ul><li>
Master of Science degree from an accredited college or university in a data driven research-related field (such as nursing, allied health, biological sciences, chemistry, economics, informatics, mathematics, psychology, sociology, epidemiology, public health).</li><li>
Oncology Certified Nurse (OCN) through the Oncology Nursing Certification Corporation (ONCC).</li><li>
Knowledge and understanding of clinical research healthcare science and Good Clinical Practice (GCP) international quality standards for clinical research.
</li><li>Knowledge of clinical research practices including federal regulations, federal grant and clinical trials policy and regulations, management systems and technology solutions used to coordinate clinical research.</li><li>
One (1) to three (3) years relevant work experience in a clinical or healthcare setting
</li><li>Certified Clinical Research Coordinator (CCRC) or Certified Clinical Research Professional (CCRP) through the Association of Clinical Research Professionals (ACRP) or the Society of Clinical Research Associates (SOCRA).</li></ul>
Work Hours:: 8:00AM-4:30PM Weekend Requirements:: No On-Call Requirements:: No</div>

Oncology Clinical Research Nurse, Atlanta Hub

Incredible Health

<div>
 Hospitals on Incredible Health are actively hiring and accepting applications in the Atlanta, GA area for the following position: Register Nurse - Primary Care/Internal Medicine. Nurses with experience in any of the following areas are strongly encouraged to apply: Cardiac patients, Couplet care, EKG monitoring, Educator, Fundal massage, Healing, Neuro patients, Oncology patients, Orthopedic patients, Ostomy care, PCA pumps , Traction &amp; cast care, Tube feeding management, or Wound &amp; drain care.
 
 
 <ul>
 <li>
 Shift(s) available: day shift, night shift, and mid shift
 </li>
 <li>
 Job types available: full time, part time, and per diem
 </li>
 <li>
 Employer features: Academic medical center, Best Places to Work recognition, Best Places to Work recognition, Cross training, Level 1 trauma center, Magnet recognized, Teaching Hospital, Union facility, U.S. News best hospital, U.S. News best hospital
 
 
 </li>
 </ul>
 
 Qualifications
 
 
 
 <ul>
 <li>
 RN Diploma degree or higher from an accredited school of nursing
 </li>
 <li>
 Active and unencumbered Registered Nurse license in the state of Georgia
 
 
 </li>
 </ul>
 
 Benefits
 
 
 
 <ul>
 <li>
 Healthcare coverage: Medical, Dental, Vision
 </li>
 <li>
 401K
 </li>
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 Paid Time Off
 </li>
 <li>
 Tuition Assistance
 
 
 </li>
 </ul>
 Salary: $59,640 to $100,000 /year
</div>

Register Nurse - Primary Care/Internal Medicine

PruittHealth

<div>
 
 REGISTERED NURSE INFECTION PREVENTIONIST
 
 
 
 
 Join the PruittHealth family, where the health and safety of our workforce is our top priority!
 
 
 
 We're not only committed to your career, we're committed to the health and safety of all our nurses. Now is a great time to make a change and join one of the leading providers of post-acute care.
 
 
 
 PruittHealth will help you conquer your career goals.
 
 At PruittHealth, we are searching for nurses who are committed to serving our residents with care and compassion, and in return, we are committed to supporting your nursing career through annual merit increases, career growth programs, preceptorship, and more.
 
 
 
 Investing In Our Employee-Partners With Benefits
 
 
 
 <ul>
 <li>
 Advance pay option
 </li>
 <li>
 Annual merit increases
 </li>
 <li>
 Relocation opportunities
 </li>
 <li>
 Paid onboarding &amp; orientation
 </li>
 <li>
 Preceptorship Program &amp; hands-on training
 </li>
 <li>
 24 / 7 direct hotline support
 </li>
 <li>
 Nurse Career Growth Program
 </li>
 <li>
 Employee Referral Bonus Program
 </li>
 <li>
 Access to PruittHealth Foundation &amp; PruittHealth University resources
 </li>
 <li>
 Comprehensive health plans
 
 
 </li>
 </ul>
 
 Responsibilities
 
 
 
 <ul>
 <li>
 Commitment to caring for patients and partners
 </li>
 <li>
 Proactive, collaborative team member
 </li>
 <li>
 Respect and professionalism towards your colleagues in the workplace at all times
 
 
 </li>
 </ul>
 Active, current, unrestricted Registered Nurse (RN) licensure in the state of practice
 
 
 
 Family Makes Us Stronger.
 
 Our family, your family, one family. Committed to loving, giving, and caring. United in making a difference.
 
 
 We are eager to connect with you!
 
 Apply Now
 
 to get started at PruittHealth!
 
 
 As an Equal Employment Opportunity employer, all qualified applicants will receive consideration without regard to race, color, religion, sex, national origin, disability, or veteran status.
 
 
 
 Job
 
 
 
 Nursing
 
 
 
 Primary Location
 
 
 
 Georgia-Atlanta
 
 
 
 Schedule
 
 
 
 Full-time
 
 
 
 Shift
 
 
 
 1st Shift
 
 
 
 Job Posting
 
 
 
 Oct 29, 2025, 3:47:10 PM
 
 
 
 Work Locations
 
 
 
 PruittHealth - Brookhaven
</div>

Registered Nurse - Infection Preventionist

Developmental Disabilities Ministries, Inc.

Job Summary:The Developmental Disability Nurse &ndash; Oversight provides clinical oversight and monitoring to ensure that individuals with intellectual and developmental disabilities receive quality, person-centered health services in compliance with Centers for Medicare &amp; Medicaid Services (CMS) guidelines and Department of Behavioral Health and Developmental Disabilities (DBHDD) standards. This role ensures that nursing and healthcare services delivered by providers align with regulatory expectations for safety, documentation, care coordination, and clinical best practices.Key Responsibilities:<ul><li>Conduct oversight visits to group homes, and other service sites to assess compliance with DBHDD and CMS standards for nursing care and health services.</li><li>Monitor and review health-related documentation, including Health Risk Screening Tools (HRST), Individual Service Plans (ISPs), medication administration records (MARs), incident reports, and nursing care plans.</li><li>Write a care plan that addresses ROB (Risk, Obstacles, and Barriers)</li><li>Provide clinical assessments and make recommendations to improve care delivery and mitigate risks to individuals served.</li><li>Ensure implementation of person-centered planning and health services coordination.</li><li>Participate in mortality reviews, incident investigations, and quality assurance activities as required.</li><li>Collaborate to develop and monitor corrective action plans (CAPs) when deficiencies are identified.</li><li>Educate staff on nursing best practices, state and federal requirements, and changes in policy related to health oversight.</li><li>Act as a liaison between healthcare professionals, and family members.</li><li>Maintain accurate and timely oversight documentation in accordance with agency protocols.</li><li>Stay current with CMS, DBHDD, and state regulations affecting developmental disability nursing care.</li></ul>Qualifications:Education and Licensure:<ul><li>Registered Nurse (RN) licensed in the state of Georgia.</li><li>Bachelor's Degree in Nursing (BSN) preferred; Associate&rsquo;s degree accepted with relevant experience.</li><li>HRST Clinical Reviewer Certification (or willingness to obtain).</li></ul>Experience:<ul><li>Minimum of 3 years of nursing experience, including 2 years working with individuals with intellectual and/or developmental disabilities.</li><li>Experience with Medicaid waiver services and familiarity with CMS oversight requirements.</li><li>Prior experience in clinical quality assurance, case management, or regulatory compliance preferred.</li></ul>Skills and Competencies:<ul><li>Strong clinical judgment and knowledge of chronic disease management in IDD populations.</li><li>Familiarity with CMS Quality Indicators and DBHDD Quality Management Systems.</li><li>Excellent written and verbal communication skills.</li><li>Ability to work independently and manage multiple oversight activities simultaneously.</li><li>Proficiency in using electronic health records (EHR) and Microsoft Office Suite.</li></ul>Working Conditions:<ul><li>Frequent travel within assigned regions for onsite visits.</li><li>Flexible work schedule may be required to accommodate operations.</li><li>Remote documentation and administrative work may be allowed in accordance with agency policy.</li><li>Monthly Assessments.</li></ul>Job Type: Part-timePay: $40.00 per hourWork Location: On the road

Part-Time Nurse

PT Registered Nurse

Preceptor Point LLC

We are looking for Qualified Nurse Practitioner Preceptors that can step in for clinical mentorship.Qualified Preceptors who move forward will receive:<ul><li>Direct compensation up to $1,500 per student, upon completion</li><li>Ability to choose from prescreened students that meet proper criteria</li><li>Individual contact assigned to guide through the process</li><li>Opportunity for future work with qualified students</li><li>Potential for additional compensation through generous referral bonus</li></ul>Qualified candidates will have:<ul><li>1+ years of experience in a clinical setting (NP, MD, PA, DO)</li><li>Active license that is currently in a good standing</li><li>Available clinical setting that is open to and comfortable with preceptorship</li><li>A desire to provide high quality training for the next generation of nursing</li><li>Currently working with a specialty in Acute Care</li></ul>We are striving to create a stress-free point of contact between students and preceptors. If you are interested in ushering in the next generation, and getting compensated along the way, apply below.Applications being accepted in GA.Job Types: Full-time, Part-timePay: From $1,000.00 per monthExperience:<ul><li>Primary Care: 1 year (Preferred)</li></ul>License/Certification:<ul><li>Certified Nurse Practitioner (Preferred)</li></ul>Work Location: On the road

PAID Adult Gerontology Acute Care PA Mentor NEEDED

Explore 224+ Utilization management nurse consultant in Atlanta United States this November. Find roles across top companies and apply now to boost your career.