Review Nurse, EDWP, SOURCE, CCSP

Alliant Health Solutions

. Perform complete medical review and appropriate processing of initial and continued placement level-of-care determinations for SOURCE and CCSP programs .

Posted 9/19/2026full-timeAtlanta • United StatesMid-LevelSeniorWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in medical review and level-of-care determinations, ensuring compliance with Department of Community Health policies while maintaining HIPAA confidentiality. Possesses strong clinical knowledge, organizational skills, and the ability to communicate effectively with providers and clients.

Highest-signal resume keywords

Registered Nurse LicenseLevel-Of-Care DeterminationsUtilization Review ExperienceClinical Experience in Adult MedicineMicrosoft Office Proficiency

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Medical ReviewLevel-Of-Care DeterminationUtilization ReviewCase ManagementQuality AssuranceDocumentation SkillsTechnical Letter PreparationFraud DetectionDecision-MakingProblem-Solving

Soft Skills

Organizational SkillsVerbal CommunicationWritten CommunicationEmpathyTeam Collaboration

Tools & Technologies

Prior Authorization SystemWeb PortalMicrosoft OfficeInternet

Certifications & Qualifications

Registered Nurse License in Georgia

Industry Keywords

MedicaidSOURCE ProgramCCSP ProgramHIPAA ComplianceProvider EducationPerformance Improvement

About the role

Key responsibilities & impact

Perform complete medical review and appropriate processing of initial and continued placement level-of-care determinations for SOURCE and CCSP programs
Review admission necessity and appropriateness using established criteria
Ensure review documentation is complete and current in the web portal
Perform initial and reassessment level-of-care determinations for applicants and clients
Render level-of-care decisions using Department of Community Health SOURCE and CCSP policies and procedures
Document rationale for nurse reviewer decisions within contract time frames
Enter clinical review and decision information into the Prior Authorization system
Prepare technical or denial letters using specified formats
Refer cases to physician consultants when indicated
Conduct reconsiderations using stated criteria and generate final decision letters
Complete information required for appeals and fair hearings and serve as a subject matter expert when required
Participate in provider education and performance improvement/monitoring activities
Respond to provider questions through the established Contact Us format
Identify and document suspected fraud and abuse for management referral
Collaborate with team members on new projects and continuous improvement
Maintain HIPAA and company information security and confidentiality
Perform other assigned duties

Requirements

What you’ll need

Registered Nurse with current, active Georgia license required
Bachelor’s degree in nursing preferred
Minimum of three to five years of adult medicine clinical experience required
Previous Medicaid, Utilization Review, Case Management, or Quality Assurance experience preferred
Prior experience telecommuting is a plus
Strong theoretical clinical knowledge base and problem-solving skills
Strong organizational skills and ability to demonstrate work priorities
Verbal, written communication, and presentation skills
Intermediate knowledge of Microsoft Office and Internet
Ability to build rapport and work with teams and customers in person and via phone
Ability to deal with stress and challenging situations and communicate with empathy and tact
Ability to work independently and maintain a flexible schedule
Ability to travel as needed, including driving and air travel to customer locations or meetings
Ability to maintain HIPAA and company information confidentiality
Ability to regularly remain stationary, occasionally move about the office, and occasionally transport materials weighing up to 30 pounds
Ability to understand and exchange accurate information verbally and in writing
Short-term and long-term memory, abstract reasoning, and decision-making abilities may be required
Core office/business operational hours may be required

Benefits

Comp & perks

2026 Best Place to Work and Healthiest Employer designation
Flexible schedule
Remote or field work locations
Professional development through provider education and performance improvement activities
Reasonable accommodation process for disabilities