Review Nurse - EDWP (Elderly and Disabled Waiver Program)

Company: Alliant Health Solutions, Inc.
Location: Atlanta
Posted on: February 13, 2026

Job Description:

Job Description Job Description Are you interested in joining a company with a great culture, and rated a "Best Place to Work" and "Healthiest Employer" by the the Atlanta Business Chronicle? If you answered yes, this may be the opportunity for you! Currently, Alliant Health Solutions is seeking a Review Nurse - Elderly & Disabled Waiver Programs (EDWP), also known as SOURCE and Community Care Service Programs (CCSP), for Atlanta Metro Area. This position is hybrid/remote, and candidate must be located in the state of Georgia. The EDWP Review Nurse, as a member of a professional multi-disciplinary team, is responsible for the complete medical review and appropriate processing of all initial and continued stay reviews for the Elderly and Disabled Waiver Programs as contracted by Georgia Medical Care Foundation in the Medical Management Contract (MMC). The EDWP Review Nurse performs reviews addressing the level of care and the appropriateness of initial and continued placement applications utilizing the established federal institutional level of care criteria. In addition, the Review Nurse accurate details of the clinical review and decision information into Prior Authorization system on initial and continued placements, prepares denial letters, and participates in hearings when needed. Some work from home office is allowed post orientation. Training on how to become an expert witness for administrative law judge hearings will be provided. In this role, the ideal candidate will do the following: Ensures the required review documentation is complete and current in the web portal prior to review. Accurately and efficiently performs initial and reassessment level of care determinations for applicants/clients requesting admission and continued placement to the EDWP Program. Accurately render appropriate level of care decisions based on the information received using the DCH EDWP Policies and Procedures; and clearly and concisely documents the rationale for all nurse reviewer decisions in the web portal and in accordance with applicable time frame requirements of the contract. Performs accurate data entry of clinical review and decision information into PA system. Prepares technical or denial letters using specified format. Refers cases appropriately to the physician consultant for review when indicated. Conducts reconsiderations of decisions when new information is submitted utilizing stated criteria as outlined in the EDWP Manual and generates final decision letters. Completes summary information required for appeals and fair hearings in a timely manner, and serves as a subject matter expert in hearings when required. Participates in provider education and performance improvement/monitoring activities as required. Responds to provider questions through “Contact Us” established format. Identifies and documents suspected cases of fraud and abuse (e.g. up coding) to Manager, for further referral to Deputy Director, Medical Review. Work in close collaboration with other team members to support the development of new projects and the continuous improvement of the overall work of the team. Promote core values of team work, professionalism, effective communication skills and positive behavior. Maintain security and confidentiality of all information in accordance with HIPAA laws, regulations, and company policies. Demonstrate compliance with corporate and departmental policies as evidenced by attendance, punctuality, and professional appearance. Performs other duties as assigned. Knowledge, skills and abilities required for this role include: Strong theoretical clinical knowledge base and problem-solving skills Must have strong organizational skills with ability to demonstrate the work priorities. Must have verbal and written communication and presentation skills Computer literate with intermediate level knowledge of Microsoft Office and Internet Ability to build rapport, work with team and interact well with team and customers in person and via phone Ability to deal with stress and challenging situations and communicate with empathy and tact Must be able to work independently and maintain a flexible schedule Must be able to travel, either driving and/or going on airplane to customer locations or meeting, if needed Education, experience and training required and preferred for the position are below: Required Registered Nurse (RN) with current Georgia license required Minimum 3 years of adult clinical experience in a long-term care, home health, hospital or direct patient-care setting Experience with clinical assessments, critical-thinking and documentation skills Preferred Bachelor's degree in nursing Previous experience in Medicaid, utilization review (UR), case management, or quality assurance Previous experience with minimum data set (MDS) Prior experience working hybrid or telecommuting Alliant knows people thrive when they feel supported, so we offer flexibility, work/life balance and great benefits including medical, dental life, disability, paid-time off, retirement with match and contribution, disability, employee assistance program, parental life, and more. If interested, click the apply icon above to apply. Alliant Health Group ("the Company) is an Equal Opportunity Employer and Drug Free Workplace. In compliance with the American's with Disability Act (ADA) and Amendments Act (ADAAA), all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender, gender identity, national origin, disability or veteran status. If you are an individual with a disability and require a reasonable accommodation to complete any part of the application process, please let us know. Likewise, if you are limited in the ability to access or use this online application process and need an alternative method for applying, we will determine an alternative method for you to apply. Please contact 678-527-3000.

Keywords: Alliant Health Solutions, Inc., Redan , Review Nurse - EDWP (Elderly and Disabled Waiver Program), Healthcare , Atlanta, Georgia