- CenterWell (Nashville, TN)
- …RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability ... Therapy, DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare… more
- Humana (Nashville, TN)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- Jennie Stuart Medical Center, Inc. (Hopkinsville, KY)
- Jennie Stuart Health is seeking a dedicated Case Management Nurse to join our healthcare team on a PRN basis. This role is integral to our patient care system, ... psychosocial support throughout the continuum of care. The Case Management Nurse will be based at our...teamwork + Experience with InterQual criteria + Understanding of utilization management + Knowledge of CMS regulations… more
- Evolent (Nashville, TN)
- …Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. Tasks are performed ... medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care across the continuum… more
- Jennie Stuart Medical Center, Inc. (Hopkinsville, KY)
- …by obtaining vital signs, providing personal care items and room orientation. Utilization of critical thinking skills in prioritization of care. Ability to identify ... and copying of all paperwork. Coordinates with nursing supervisor and/or materials management for supply items that cannot be obtained from the Pyxis. Ensures… more
- Vanderbilt University Medical Center (Nashville, TN)
- …to impact pediatric patients and families from the beginning - Autonomy and Utilization of Critical Skills - Teamwork that displays comradery and family center care ... * Analyzes comprehensive information pertinent to the patient's care and management to determine nursing diagnosis. * Continually utilizes the nursing process… more
- Fresenius Medical Center (Cadiz, KY)
- …Classification of Disease (ICD) coding. + Manages clinic financials including efficient utilization of supplies or equipment and regular profits and loss review. + ... + Preferred but not required: + 3+ years supervisory or project/program management experience. + Med/surg or ICU/CCU experience. **PHYSICAL DEMANDS AND WORKING… more
- HealthTrust Workforce Solutions (Nashville, TN)
- …budget and resource management , cost control, contract compliance, quality improvement, utilization management , denials management and management of ... jobs nationwide. **_JOB SUMMARY_** The Interim Leader of Case Management Services is a Registered Nurse who...that the following functions of the role are completed: Utilization Review for medical necessity of admission and concurrent… more
- HCA Healthcare (Nashville, TN)
- …want to join an organization that invests in you as a Director Case Management ? At TriStar Skyline Medical Center, you come first. HCA Healthcare has committed up ... difference. We are looking for a dedicated Director Case Management like you to be a part of our...to ensure continuity of care and optimal clinical resource utilization . The Director has oversight for all aspects of… more
- Adecco US, Inc. (Nashville, TN)
- **Case Management Director** **Position Title:** Director of Case Management **Location:** Nashville, TN **Position Type:** Full-Time | Day Shift (No Weekends) ... available on a case-by-case basis) **Position Overview** The Director of Case Management is responsible for the overall leadership, management , and coordination… more
- Select Medical (Nashville, TN)
- … within the plan of care. + Demonstrates compliance with facility-wide Utilization Management policies and procedures. + Coordinates UR compliance with ... current licensure in a clinical discipline either as a Nurse or a Respiratory Therapist OR Social Work SW/MSW...what is right. The Case Manager is responsible for utilization reviews and resource management , discharge planning,… more
- Select Medical (Nashville, TN)
- … within the plan of care. + Demonstrates compliance with facility-wide Utilization Management policies and procedures. + Coordinates UR compliance with ... current licensure in a clinical discipline either as a Nurse or a Respiratory Therapist OR Social Work SW/MSW...what is right. The Case Manager is responsible for utilization reviews and resource management , discharge planning,… more
- HCA Healthcare (Nashville, TN)
- …required (LPC, LMFT, LCSW, LADAC) + Previous experience in Needs Assessment and Utilization Management strongly preferred. + Familiarity with required DSM V-R ... nurses play a vital part. We know that every nurse 's path and purpose is unique. Do you want...reimbursed by contacting managed care organizations and completing initial utilization review. Documents in Midas as required. Involves mobile… more
- Intermountain Health (Nashville, TN)
- …+ Care Management Certification + Demonstrated experience in case management , utilization review, or discharge planning. + Bi-Lingual/Spanish Speaking ... The RN Ambulatory Care Manager I delivers comprehensive ambulatory care management services to identified patients. Leveraging clinical expertise, this role involves… more
- Sharecare (Nashville, TN)
- …/ new hire plan selection, claims issues, ID card issues, grievances/appeals, utilization management (UM) status, including but not limited to medical, ... + Claims adjustments + Grievances and appeals submissions + Utilization management intake or status + Complex...and second opinion. + Referring members to Clinical Advocates ( Nurse ) for conditions that require clinical care and case… more
- STG International (Hopkinsville, KY)
- …to ensure compliance and patient safety. * Participates in quality improvement, care management , risk management , peer review, utilization review, clinical ... Participate in the orientation of clinical staff physicians, physician assistants and nurse practitioners. * Provide leadership to CBOC clinicians. * Evaluate the… more
- HCA Healthcare (Nashville, TN)
- …department performance in accordance with established budget, including the utilization of staffing, supplies, equipment identifying cost reduction opportunities to ... nursing practice of the organization through clinical education and competency management + Consistently seeks improvement opportunities to enhance the effectiveness… more
- Trevecca Center for Rehabilitation and Healing (Nashville, TN)
- …the administrator in development of the annual budget. Appropriate and effective utilization of staff. Managing key operations and financial levers to achieve budget ... in the facility's Employee Handbook and as communicated by the facility's management . Contributing to a positive work team by sharing information, using problem… more
- Highmark Health (Nashville, TN)
- …and education or if necessary involve Special Investigation Unit or the Utilization Management area. **ESSENTIAL RESPONSIBILITIES** + Implement the pre-payment ... itemized bills, and claims data to assure appropriate level of payment and resource utilization . It is also used to identify issues which can be used for education… more
- Deloitte (Nashville, TN)
- …to collaborate with clinicians, physicians, NP/PAs, ancillary departments, Quality, Case Management , Finance, Revenue Cycle, and Coders + Other skills include the ... both formal and informal education of physicians, CDI team, health information management and other clinical staff + Develop in-service education tools as necessary… more