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Precertification Nurse Jobs in Georgia (NOW HIRING)

Kaiser Permanente

RN, Targeted Review

Atlanta, GA · On-site

Responsible for carrying out precertification and medical necessity reviews on all designated ... The activities will include telephonic review for medical necessity of the RN designated targeted ...

Alliant Health Group

Review Nurse-PA/UM

Atlanta, GA · On-site

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 ...

St. Joseph's/Candler

Nurse Practitioner

Savannah, GA · On-site

$46.14/hr

Nurse Practitioners may instruct and counsel patients and their families, and involve them in ... Ensures precertification is obtained when needed prior to services being rendered. Follows referral ...

St. Joseph's/Candler

Nurse Practitioner

Savannah, GA · On-site

$46.14/hr

Nurse Practitioners may instruct and counsel patients and their families, and involve them in ... Ensures precertification is obtained when needed prior to services being rendered. Follows referral ...

St. Joseph's/Candler

Nurse Practitioner

Savannah, GA

$46.14/hr

Nurse Practitioners may instruct and counsel patients and their families, and involve them in ... Ensures precertification is obtained when needed prior to services being rendered. Follows referral ...

St Joseph'S/Candler

Nurse Practitioner

Savannah, GA · On-site

Nurse Practitioners may instruct and counsel patients and their families, and involve them in ... Ensures precertification is obtained when needed prior to services being rendered. Follows referral ...

Amedisys, Inc.

RN Clinical Manager

Demorest, GA · On-site

$88K - $95K/yr

Oversees payor verification and precertification requirements. * Reviews documentation of other ... One year of clinical RN experience in home health or hospice. * One year of RN management ...

Amedisys, Inc.

RN Clinical Manager Home Health

Atlanta, GA · On-site

$92K - $110K/yr

Oversees payor verification and precertification requirements. * Reviews documentation of other ... Current RN license, specific to the state(s) you are assigned to work. * One year of clinical RN ...

Amedisys, Inc.

RN Clinical Manager Home Health

Winder, GA · On-site

$90K - $105K/yr

Oversees payor verification and precertification requirements. * Reviews documentation of other ... Current RN license, specific to the state(s) you are assigned to work. * One year of clinical RN ...

Amedisys, Inc.

RN Clinical Manager Home Health

Griffin, GA · On-site

$83K - $90K/yr

Oversees payor verification and precertification requirements. * Reviews documentation of other ... Current RN license, specific to the state(s) you are assigned to work. * One year of clinical RN ...

Amedisys, Inc.

RN Clinical Manager Home Health

Winder, GA · On-site

$90K - $105K/yr

Oversees payor verification and precertification requirements. * Reviews documentation of other ... Current RN license, specific to the state(s) you are assigned to work. * One year of clinical RN ...

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All JobsPrecertification Nurse JobsPrecertification Nurse Jobs in Georgia

Precertification Nurse information

See Georgia salary details

$13

$30

$50

How much do precertification nurse jobs pay per hour?

As of Aug 28, 2026, the average hourly pay for precertification nurse in Georgia is $30.49, according to ZipRecruiter salary data. Most workers in this role earn between $23.75 and $37.16 per hour, depending on experience, location, and employer.

What is a precertification nurse?

Precertification Nurses are registered nurses who review medical procedures, treatments, or hospital admissions to determine if they are medically necessary and covered by a patient's health insurance plan. They act as a liaison between healthcare providers, insurance companies, and patients, ensuring that all required documentation is complete before care is authorized. Their work helps prevent unnecessary treatments, controls healthcare costs, and ensures compliance with insurance policies. Precertification Nurses often work for insurance companies, hospitals, or managed care organizations.

What are some common challenges a precertification nurse faces when coordinating with insurance providers?

One common challenge Precertification Nurses encounter is navigating varying insurance policies and requirements, which can change frequently and differ between providers. This often involves detailed communication with both patients and insurance representatives to ensure all necessary documentation is submitted for timely approvals. Additionally, managing high volumes of precertification requests while maintaining accuracy and meeting deadlines can be demanding. Effective organization, attention to detail, and strong interpersonal skills are essential to succeed in this fast-paced environment.

What are the key skills and qualifications needed to thrive as a precertification nurse, and why are they important?

To thrive as a Precertification Nurse, you need a solid clinical background, expert knowledge of insurance guidelines, and an active RN license. Familiarity with utilization management systems, medical coding, and precertification software is typically required. Strong attention to detail, effective communication, and critical thinking skills help nurses advocate for patients and coordinate with providers and insurers. These skills are vital for ensuring appropriate care authorization, reducing claim denials, and supporting efficient healthcare delivery.

What is the difference between Precertification Nurse vs Utilization Review Nurse?

AspectPrecertification NurseUtilization Review Nurse
CertificationsRN license, possibly certifications in case management or healthcare qualityRN license, certifications in case management or healthcare quality
Work EnvironmentInsurance companies, healthcare providers, or third-party review organizationsInsurance companies, healthcare facilities, or third-party review organizations
Primary FocusPre-authorization of procedures and services before deliveryReview of services already provided for appropriateness and necessity

Precertification Nurses focus on obtaining approval before procedures, while Utilization Review Nurses evaluate the necessity of services after they are performed. Both roles require similar credentials and often work in the same environments, but their primary responsibilities differ in timing and purpose.

What are popular job titles related to Precertification Nurse jobs in Georgia?

For Precertification Nurse jobs in Georgia, the most frequently searched job titles are:

What job categories do people searching Precertification Nurse jobs in Georgia look for?

The top searched job categories for Precertification Nurse jobs in Georgia are:

Precertification Nurse jobs near you
Infographic showing various Precertification Nurse job openings in Georgia as of August 2026, with employment types broken down into 100% Full Time. Highlights an 100% In-person job distribution, with an average salary of $63,410 per year, or $30.5 per hour.

RN, Targeted Review

Atlanta, GA • On-site

Kaiser Permanente
Health Care and Social Assistance • 10K+ employees

8.2

Company rating: 8.2 out of 10

Based on 923 frontline employees who took The Breakroom Quiz

54th of 895 rated healthcare providers

People enjoy working here

Good employer

Recommended by students

Learn more about Kaiser Permanenteexternal

Other

Medical

Re-posted 2 days ago

Job description

Description:
Sign on bonus $10,000 possible eligible
Job Summary:
Responsible for carrying out precertification and medical necessity reviews on all designated referrals as well as targeted outpatient procedures, services and inpatient admissions. The activities will include telephonic review for medical necessity of the RN designated targeted outpatient procedures, services and inpatient admissions, as well as referrals, utilizing established criteria and guidelines, retrospective ED reviews. In addition, they will perform eligibility and benefit reviews as necessary, identification of patients for case management, quality improvement reviews, and communicate with inpatient care coordinators, case managers, the SNF/Rehab care coordinator, members, providers, Customer Service, Claims, Contracts and Benefits - Appeals, Risk Management.
Essential Responsibilities:
  • Responsible for the day to day precertification and review activities as outlined above. Utilizes established criteria to perform precertification and referral review for all members requiring a procedure or service or with an admission diagnosis on the targeted review list for the RN. All referrals and precertification reviews will be performed within the required timeframe and the provider and member notified of the results. Refers all cases that do not meet established criteria to the appropriate review physician. Performs questionable benefit and eligibility reviews. Provides investigation and preparation of cases requiring review of the Chief of QRM: Non Contracted Providers Question of internal referral versus external referral or non-contract consultant performing services that can be provided internally. Any referral questionable for benefit Breast Reduction/Augmentation Varicose Veins Possible experimental/investigational procedures or treatments TMJ diagnoses. Referrals that are not approved due to not meeting medical appropriateness criteria. Understands the Complex Case Management Program and admission criteria and refers patients to the Complex Case Managers as appropriate. Provide correspondence, written and verbal, in accordance to policy and procedure for members with respect to referrals. Provides review of pended bills for specific types of referral cases.Interacts with physicians to ensure that resources are being utilized appropriately while maintaining quality outcomes. Establishes and maintains contact with patients and their families as appropriate, including the provision of education when needed. Refers the patient to the home care review team and/or social workers as appropriate. Ensures that the appropriate level of care is being delivered in the most appropriate setting based on established criteria and guidelines. Performs quality of care and service reviews using identified quality indicators. Coordinates and assists the Specialty Care Review Service$ Supervisor with ongoing physician education.
  • Reviews the monthly analysis of statistics (cost/benefit) with the Specialty Care Review Services Supervisor and makes adjustments based on findings. Remains knowledgeable of contract benefits and current, relevant state and Federal regulations, criteria, documentation requirements and laws that affect managed care and case/utilization management. Maintains effective interaction/communication with members of the medical staff, nursing staff, complex case managers, the SNF rounder, home care review team, social workers, inpatient care coordinators, referral coordinators, Member Services, Claims, Contracts and Benefits-Appeals, Risk Management and Kaiser Permanents medical offices to facilitate the precertification and referral process. Builds effective working relationships with physicians and other departments within the health plan. Assists in the development and revision of guidelines, pathways and protocols. Attends QRM Hospital UM meetings as requested. Investigates, identifies and reports problems and inefficiencies in existing systems, and recommends changes when appropriate to the Review Services Supervisor. Under the guidance of the Review Services Supervisor and in consultation with other QRM staff, participates in the coordination, planning, development, implementation, and maintenance of all QRM policies and procedures related to the Specialty Care Review Program. Monitors utilization trends in the market area, keeping appropriate management informed. Initiates recommendations to facilitate reductions in utilization where appropriate. Refers cases identified as risk management, peer review or quality issues to QAIR and Risk Management.
  • Document Review Activities to include: Medical necessity for admission/procedure. Diagnoses. Procedures performed. Demographic Data. Physicians involved in care. Other. Issue letters of non - coverage to members not meeting established medical necessity criteria. Works cross-functionally with other departments in striving to meet organizational goals and objectives. Achieves and maintains an understanding of relevant state and federal regulations, criteria, and documentation requirements and laws that affect managed care, home health and case/utilization management. Knowledgeable and compliant with regional personnel policies and procedures. Knowledgeable and compliant with QRM departmental and unit specific policies and procedures. Participates in annual regional and departmental compliance training. Knowledgeable and compliant with Principles of Responsibility. Develops and maintains an awareness of how to report compliance issues and concerns. Other duties as assigned.
Basic Qualifications:
Experience
  • Minimum three (3) years of RN clinical nursing.
Education
  • High school diploma or GED required.
License, Certification, Registration
  • Registered Professional Nurse License (Georgia) required at hire
Additional Requirements:
  • Working knowledge of all relevant federal, state, local and regulatory requirements including Medicare.
  • Functional knowledge of computers.
  • Experience with Managed Health Care Delivery Systems.
  • Experience in ICD9/CPT4 coding.
Preferred Qualifications:
  • Minimum three (3) years of clinical nursing; experience in ICU or medical/ surgical nursing care preferred.
  • Minimum two (2) years of experience in utilization or case management, discharge planning and quality improvement in a health care or managed care setting preferred.
  • Bachelors degree (B.S.) in nursing.

Primary Location: Georgia,Atlanta,Regional Office - 9 Piedmont
Scheduled Weekly Hours: 40
Shift: Day
Workdays: Mon, Tue, Wed, Thu, Fri, Sat, Sun
Working Hours Start: 08:30 AM
Working Hours End: 05:00 PM
Job Schedule: Full-time
Job Type: Standard
Worker Location: Onsite
Employee Status: Regular
Employee Group/Union Affiliation: GUP|UFCW|Local 1996
Job Level: Entry Level
Department: Regional Office - 9 Piedmont - Utilization Management - 2808
Pay Range: $40.66 - $51.97 / hour Kaiser Permanente strives to offer a market competitive total rewards package and is committed to pay equity and transparency. The posted pay range is based on possible base salaries for the role and does not reflect the full value of our total rewards package. Actual base pay determined at offer will be based on labor market data, internal alignment, and a candidate's years of relevant work experience, education, certifications, skills, and geographic location.
Travel: No
On-site: Work location is on-site (KP designated office, medical office building or hospital). Worker location must align with Kaiser Permanente's Authorized States policy. Kaiser Permanente is an equal opportunity employer committed to fair, respectful, and inclusive workplaces. Applicants will be considered for employment without regard to race, religion, sex, age, national origin, disability, veteran status, or any other protected characteristic or status.

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