Review Nurse, SOURCE & CCSP Waiver Programs

Alliant Health Solutions, Inc.; Atlanta (GA); On-site; USD 70,000 - 90,000; Full time

Job summary

Alliant Health Solutions is seeking a Review Nurse for the Elderly and Disabled Waiver Program (EDWP) and CCSP/SOURCE in Atlanta, GA. You will perform initial and continued level of care determinations, document rationale, and prepare letters within contract timelines.

Requires Georgia RN license, 3–5 years adult medicine or utilization review experience, strong organization, and communication skills. Some travel may be required; telecommuting not offered.

Qualifications

• RN license active in Georgia required.
• Bachelor’s degree in nursing preferred.
• Minimum 3–5 years of adult medicine experience.
• Experience with Medicaid/Utilization Review/Quality Assurance preferred.

Responsibilities

• Review initial and reassessment level of care determinations for SOURCE/CCSP.
• Document rationale for nurse reviewer decisions in web portal and contract timelines.
• Enter clinical review data into Prior Authorization system.
• Prepare technical or denial letters using specified formats.
• Refer cases to physician consultant when indicated.
• Participate in provider education and performance improvement activities.

Skills

Organizational skills

Verbal communication

Written communication

Team collaboration

Education

Georgia RN license

BSN preferred

Tools

Microsoft Office

Job description

Alliant Health Solutions is seeking a Review Nurse for the Elderly and Disabled Waiver Program (EDWP) and CCSP/SOURCE in Atlanta, GA. You will perform initial and continued level of care determinations, document rationale, and prepare letters within contract timelines.

Requires Georgia RN license, 3–5 years adult medicine or utilization review experience, strong organization, and communication skills. Some travel may be required; telecommuting not offered.