Utilization review nurse jobs in Atlanta, GeorgiaCreate job alerts

GHR Healthcare - PH Division is seeking a travel nurse RN Case Management for a travel nursing job in Atlanta, Georgia. Job Description & Requirements • Specialty: Case Management, • Discipline: RN, • Start Date: 12/22/2025, • Duration: 13 weeks, • 40 hours per week, • Shift: 8 hours \n Advance your nursing career as a Registered Nurse Case Manager in Atlanta’s prestigious Buckhead district (30305). Join a leading healthcare team specializing in care coordination for patients with complex medical needs. This travel nursing job offers the chance to work in one of Georgia’s top healthcare environments, supporting smooth transitions across clinical settings in a vibrant urban area known for its upscale amenities.\n \n\nAtlanta Healthcare Job Details\n\n • Location: Atlanta, GA 30305 (On-Site – Buckhead area)\n, • Employment Type: Travel RN Contract\n, • Duration: 13-week nursing contract\n, • Start Date: December 22, 2025\n, • Hours per Week: 40\n, • Shift: 8 Hour Day Shifts\n, • Shifts per Week: 5\n, • Estimated Weekly Pay: $2,345 - $2,606\n\n\nRN Case Manager Qualifications\n\n, • Active Registered Nurse (RN) license in Georgia or compact state\n, • Minimum 1 year of recent experience in case management, care coordination, or utilization review\n, • Preferred experience in skilled nursing, acute transitional care, or clinical support roles\n, • Completion of nursing skills checklist and license verification\n, • Two professional references required\n, • Excellent communication, organizational, and collaboration skills\n\n\nCase Manager RN Responsibilities\n\n, • Coordinate patient care for individuals with complex medical conditions in partnership with hospital physicians, QRM staff (IPCC, CM, SW, PTSP), and other healthcare professionals\n, • Facilitate seamless transitions from acute care or skilled nursing facilities to home or alternative care settings\n, • Conduct utilization reviews to ensure appropriate level of care and optimal resource utilization\n, • Engage patients, families, and multidisciplinary teams to develop and implement personalized care plans\n We believe in empowering your career. From your first conversation, you’ll partner with a dedicated career advisor who understands your aspirations and connects you with top-tier job openings that align with your skills, goals, and earning potential. Our team works to deliver highly competitive salaries and benefits, ensuring your valuable expertise is recognized and rewarded. We’re here to help you unlock new opportunities, advance your career, and create a meaningful impact in healthcare. Explore our job opportunities at jobs.ghrhealthcare.com. Equal Opportunity We are an equal opportunity employer and value diversity across our organization. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status. Planet Healthcare Job ID #438174. Pay package is based on 8 hour shifts and 40 hours per week (subject to confirmation) with tax-free stipend amount to be determined. Posted job title: Case Management About GHR Healthcare - PH Division For over 30 years, GHR Healthcare has been the bridge between healthcare professionals and the facilities that need them nationwide. We're committed to uncovering your ideal fit, supported by GHR's dedication to competitive compensation, transparent communication, and a devoted team that genuinely cares about your career journey. You can trust us to stand by your side as your advocate, confidante, and partner in advancing your career. At GHR, care and consideration are at the heart of everything we do. Visit ghrhealthcare.com to learn more.

Olaro is seeking a travel nurse RN Care Manager for a travel nursing job in Atlanta, Georgia. Job Description & Requirements • Specialty: Care Manager, • Discipline: RN, • Start Date: 01/05/2026, • Duration: 12 weeks, • 40 hours per week, • Shift: 8 hours, days, • Employment Type: Travel 462882 Case Manager RN – Utilization Review & Care Coordination | Emory St. Joseph’s & Emory Decatur Locations: • Emory St. Joseph’s Hospital This role requires strong critical thinking, clinical judgment, and experience with utilization review criteria such as MCG. Key Responsibilities • Conduct utilization review to ensure appropriate level of care, • Develop and manage individualized discharge plans, • Coordinate care across interdisciplinary teams, including physicians, social workers, and ancillary services, • Communicate with payers, providers, and patients to support safe transitions of care, • Ensure documentation standards are met in Epic, • Support quality and compliance initiatives within the Case Management department, • May float to Emory Decatur as workload requiresRequired Qualifications, • Active RN license (state-specific per assignment), • BLS (AHA), • Utilization Review / Case Management experience, • Proficiency with:, • MCG (Milliman), • Epic EMR Olaro is a trusted partner in healthcare staffing, connecting nurses and allied health professionals with opportunities nationwide. For over 35 years, we’ve helped clinicians expand their horizons by matching them with assignments that fit their lifestyle, career goals, and personal ambitions. At Olaro, we value your expertise and support your growth at every step. We offer competitive pay, comprehensive benefits, and access to diverse clinical experiences that build your skills and open doors to new possibilities. With 24/7 support, streamlined onboarding, and a team committed to your success, you’ll always have a proven guide by your side. Whether you want to explore new locations, broaden your clinical experience, or achieve better work–life balance, Olaro provides the flexibility and support to help you thrive. Join us, and let’s shape the future of healthcare together.

The Case Manager RN supports safe, efficient, and patient-centered transitions of care across the Emory Healthcare system. Olaro is seeking a travel nurse RN Care Manager for a travel nursing job in Atlanta, Georgia. Case Manager RN – Utilization Review & Care Coordination | Emory St.

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, • 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 Required: • Registered Nurse, with at least three years of recent clinical experience required 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.

Title: Utilization Review Nurse Location: Fully Remote must reside in - TX/IL Duration: 6 months Contract (Possible Extension) Schedule: Monday – Friday, 8:00 AM – 5:00 PM Pay Rate : $40/hr - $41/hr on W2 Job Description: • RN working in the insurance or managed care industry using medically accepted criteria to validate the medical necessity and appropriateness of the treatment plan., • This Position Is Responsible for Performing Accurate and Timely Medical Review of Claims Suspended for Medical Necessity, Contract Interpretation, Pricing; And to Initiate And/or Respond to Correspondence from Providers or Members Concerning Medical Determinations., • Knowledge of accreditation, i.e., URAC, NCQA standards and health insurance legislation., • Awareness of claims processes and claims processing systems. PC proficiency to include Microsoft Word and Excel and health insurance databases., • Verbal and written communication skills with ability to communicate to physicians, members and providers and compose and explain document findings., • Organizational skills and prioritization skills. :Registered Nurse (RN) with unrestricted license in state., • 3 years clinical experience.