Remote Denial Prevention Analyst Jobs in Decatur, GA

At AMC Health, we deliver advanced virtual caregiving through a whole-person, data-driven approach. Our mission is to improve clinical outcomes and health equity by combining compassionate care with real-time data, advanced analytics, and innovative technology. We empower clinicians to practice at the top of their license while helping patients heal safely and comfortably at home.

Position Summary

The Telephonic Nurse Care Manager is responsible for the remote, telephonic management of patients with chronic and complex conditions (including but not limited to CHF, COPD, diabetes, and hypertension). This role partners closely with patients, caregivers, and interdisciplinary care teams to assess health status, develop and implement evidence-based care plans, monitor biometric and IVR data, and intervene proactively to reduce risk, prevent escalation, and improve outcomes.

This is a remote position requiring strong clinical judgment, excellent communication skills, and comfort working in a technology-enabled, fast-paced virtual care environment.

Key Responsibilities

• Conduct comprehensive telephonic and virtual clinical assessments, including review and interpretation of biometric, RPM, and IVR data with trend analysis
• Develop, implement, and adjust individualized nursing care plans aligned with patient goals, evidence-based practice, and organizational protocols
• Engage patients using Motivational Interviewing techniques to drive behavior change, adherence, and self-management
• Identify clinical risks, changes in condition, and urgent situations; escalate appropriately and in accordance with clinical guidelines
• Collaborate with interdisciplinary care teams (internal and external) to coordinate care, referrals, and transitions across the continuum
• Deliver proactive interventions aimed at reducing hospitalizations, ER visits, and overall cost of care
• Document all patient interactions accurately, timely, and comprehensively in the electronic health record (EHR)
• Participate in quality improvement initiatives, chart audits, and performance reviews to enhance clinical outcomes and care delivery
• Perform care management activities in alignment with client-specific workflows, performance expectations, and service-level requirements
• Maintain compliance with all clinical, regulatory, HIPAA, and organizational standards

Core Competencies

• Strong clinical assessment and critical-thinking skills in a remote care setting
• Excellent time management and organizational skills with the ability to prioritize effectively
• High degree of accountability for patient safety, outcomes, and care quality
• Ability to work independently while remaining highly collaborative within a virtual team
• Exceptional verbal and written communication skills
• Strong relationship-building skills with patients, caregivers, colleagues, and clients
• Comfort navigating multiple technology platforms and adapting quickly to new tools

Education & Experience Requirements

• Nursing degree from an accredited college or university (ADN or BSN required; BSN preferred)
• Minimum of 5 years of broad clinical nursing experience
• Minimum of 3 years of experience in one or more of the following:
  • Care management or care coordination
  • Home health or transitions of care
  • Telehealth or virtual care
  • Chronic disease management (e.g., cardiac, pulmonary, endocrine)
• Strong computer proficiency, including EHR documentation, navigating multiple systems, and troubleshooting basic technical issues
• Ability to work assigned time zones and schedules based on client needs

Licensure & Certification

• Active, unrestricted RN license
• Compact (NLC) license and/or California RN license required, depending on assignment

Physical Demand & Work Environment

• Fully remote/home-based role
• Private, quiet, and secure home office free from distractions
• Reliable high-speed internet meeting company requirements
• Ability to sit for extended periods and perform repetitive computer-based tasks

What We Offer

• Opportunity to work at the forefront of virtual care and remote patient monitoring
• Mission-driven culture focused on innovation, collaboration, and patient impact
• Competitive compensation and comprehensive benefits
• Supportive, remote-first work environment with growth opportunities

AMC Health is an Equal Opportunity Employer. We are committed to building a diverse and inclusive workforce.