Hybrid Review Nurse - Prior Authorization/UM

Alliant Health Solutions, Inc.; Atlanta (GA); Hybrid; USD 75,000 - 110,000; Full time

Benefits offered by this job

Medical benefits

Dental benefits

Retirement with match

Job summary

Alliant Health Solutions, Inc. in Atlanta, GA is seeking a Hybrid Review Nurse for its Prior Authorization and Utilization Management team.

The role conducts prior approval and precertification reviews for Georgia Medicaid members, collaborating with PA/UM colleagues to ensure contract expectations are met. The ideal candidate is a Registered Nurse with at least three years of clinical experience and a current Georgia nursing license.

Qualifications

• RN with 3+ years of clinical experience,
• Current Georgia nursing license required,
• Knowledge of InterQual criteria and clinical review processes preferred

Responsibilities

• Perform reviews of prior approval and precertification requests per PA/UM policy
• Evaluate initial clinical information and document rationale for decisions
• Refer cases not meeting criteria to appropriate reviewers
• Consult with Manager/Medical Directors on complex cases
• Participate in quality improvement and peer review activities
• Maintain HIPAA confidentiality and follow policies
• Collaborate with team to improve processes and outcomes
• Demonstrate teamwork, professionalism, and effective communication
• Travel as needed to company locations or meetings

Skills

ICD-10-CM

InterQual criteria

Organizational skills

Interpersonal/communication

Written/verbal skills

Independence

MS Windows familiarity

Typing 30–50 wpm

Education

RN license (GA)

Job description

Alliant Health Solutions, Inc. in Atlanta, GA is seeking a Hybrid Review Nurse for its Prior Authorization and Utilization Management team.

The role conducts prior approval and precertification reviews for Georgia Medicaid members, collaborating with PA/UM colleagues to ensure contract expectations are met. The ideal candidate is a Registered Nurse with at least three years of clinical experience and a current Georgia nursing license.