**POSITION SUMMARY:** Ensures the continuation of medically necessary services to our patients post -acute care. Demonstrates understanding of post-acute services and case management as it relates to the continuum of care. This would be a hybrid position. **ESSENTIAL JOB FUNCTIONS, DUTIES, AND RESPONSIBILITIES:** • Demonstrates the ability to understand CMS and Commercial Insurance requirements to ensure compliance with regulations and standards. • Must be knowledgeable of medical necessity review guidelines for commercial, Medicare, and Medicaid insurance products. • Uses knowledge of insurance criteria and regulations in order to expedite appropriate use of resources and compliance with third party payer contracts. • Demonstrates the ability to communicate effectively via phone and email with our internal and external customers. • Strong organization and ability to multi task is essential to success in this role. **LICENSURE, CERTIFICATION, EXPERIENCE AND EDUCATION REQUIREMENTS:** • BSN preferred • Currently licensed Registered Nurse in the state of GA. • A minimum of 3-years of clinical experience is required. • Home Health Care and or skilled nursing industry experience highly preferred. • RN Case Management experience preferred. • Must be proficient in the use of computer applications for daily use. • Highly proficient in Microsoft Word, Intermediate Excel and Outlook required **Family Makes Us Stronger.** Our family, your family, one family. Committed to loving, giving, and caring. United in making a difference. We are eager to connect with you! **_Apply Now_** to get started at PruittHealth! _As an Equal Employment Opportunity employer, all qualified applicants will receive consideration without regard to race, color, religion, sex, national origin, disability, or veteran status._