- Humana (Nashville, TN)
- …and help us put health first** Humana Healthy Horizons in Ohio is seeking a Utilization Management Nurse 2 who utilizes clinical nursing skills to support ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- Ascension Health (Nashville, TN)
- **Details** + **Department:** Utilization Management + **Schedule:** Monday - Friday. 40 hours week. + **Hospital:** Ascension Saint Thomas + **Location:** ... TN market. We're looking for an experienced Director of Utilization Management to join our team! In...Develop systems and processes for prospective, concurrent and retrospective utilization review for allself-funded and fully insured… more
- Humana (Nashville, TN)
- …us put health first** Humana Healthy Horizons in Kentucky is seeking a Utilization Management Behavioral Health Professional 2 who utilizes behavioral health ... and communication of medical services and/or benefit administration determinations. The Utilization Management Behavioral Health Professional 2 work assignments… more
- Humana (Fort Campbell, KY)
- …Previous Medicare/Medicaid experience a plus. + Previous experience in prior authorization, utilization management + Experience working with MCG or Interqual ... goal to put health first? The Prior Authorization, Registered Nurse , RN, Intern will review prior authorization... depending on case findings. + Educates providers on utilization and medical management processes. + Enters… more
- HCA Healthcare (Nashville, TN)
- …next step in your career path, we encourage you to apply for our Case Management RN opening. We review all applications. Qualified candidates will be contacted ... Do you have the career opportunities as a Case Management RN you want in your current role? We...supporting a balance of optimal care and appropriate resource utilization . What you will do in this role: +… more
- The Cigna Group (Nashville, TN)
- …at home to improve quality of life, increase understanding and management of serious illness, facilitate coordination between providers, and decrease unnecessary ... includes health risk assessments, transitions of care, complex and chronic disease management , and palliative care support. We conduct in-home longitudinal care for… more
- Vanderbilt University Medical Center (Nashville, TN)
- …Present and justify a proposed budget (operating and capital expenditure) to a management review committee. + Evaluate organizational functions and structures to ... capital expenditure budgets; and performing personnel administration functions. The Registered Nurse Director for the Digestive Disease Center will oversee the The… more
- The Cigna Group (Nashville, TN)
- …about their care options and make specific recommendations based on their goals 4. Review paperwork for patients to ensure it meets all requirements 5. Explain test ... education including possible side effects, plan of care, and individualized care goals management in a culturally sensitive and acceptable manner for the patient or… more
- Vanderbilt University Medical Center (Nashville, TN)
- …if additional records requests or actions might be indicated * Experience/proficiency in the review and the utilization of EPIC and/or eStar including the Media ... multiple team members * Comfortable changing assignment/roles every day or so * Comfortable with the clinical review of testing results and visit plans to determine… more
- Fresenius Medical Center (Cadiz, KY)
- …and acts as the liaison for patient care as per the disease management agreement, including initial and ongoing validation of member eligibility. Facilitate timely ... workup of patients for access management , dialysis services, patient education, hospitalizations, and kidney transplantation as appropriate, and ensures coordination… more
- Evolent (Nashville, TN)
- …for operational performance of physician, nursing, and shared services staff in the utilization management value chain + Owns clinical rationale for ... point of responsibility for all clinical operations inclusive of nurse , physician, and shared services performance. and core work...utilization management decisions made by all clinical staff + Ensures… more
- Ascension Health (Nashville, TN)
- …specialist for staff in the areas of utilization criteria, appeal and review process, and case management system documentation. + Develop staff schedule and ... **Details** + **Department:** Case Management + **Schedule:** Full-Time, Exempt + **Hospital:** St...One or more of the following required: + Registered Nurse credentialed from the Tennessee Board of Nursing obtained… more
- HCA Healthcare (Springfield, TN)
- …We care like family! Jump-start your career as a **RN PRN Case Management ** today with TriStar NorthCrest Medical Center. Benefits TriStar NorthCrest Medical Center, ... charitable organizations. Apply Today! Job Summary and Qualifications The Registered Nurse (RN) CM is responsible for promoting patient-centered care by coordinating… more
- Evolent (Nashville, TN)
- …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and client policies and ... behind it. **What You'll Be Doing:** The Evolent Appeals Nurse team offers candidates the opportunity to make a...and regulations. * Practices and maintains the principles of utilization management and appeals management … more
- Vanderbilt University Medical Center (Nashville, TN)
- …- Neuroscience. The Associate Nursing Officer - Neuroscience shall provide general management for the operations of a Patient Care Center by providing administrative ... * Lead activities related to performance, improvement, and risk management programs in order to establish and meet clinical...or VUMC goals. * Promote and monitor the effective utilization of the assigned space in support of the… more
- Vanderbilt University Medical Center (Nashville, TN)
- …research, and patient care missions of the University's Medical Center. * Review , establish, and revise policies, procedures, and standards related to all aspects ... Create programs to meet the future market requirements. * Monitor and review departmental performance of productivity targets. * Implement changes for improvement… more
- Intermountain Health (Nashville, TN)
- …of 2 years' experience in acute clinical nursing setting + Knowledge of utilization management and case management principles preferred KNOWLEDGE, SKILLS, ... **Job Description:** The Pre-Access Prior Authorization RN provides timely review of authorization requests and/or review of denials to ensure medical necessity,… more
- HCA Healthcare (Nashville, TN)
- …and performance of assigned home health care team(s) Supervises ongoing case management of all patients ensuring an accurate evaluation and treatment plan, ... clinicians regarding deficiencies or OASIS corrections (with feedback from Quality Review Specialist) to ensure the medical records reflect compliance with medical… more
- HCA Healthcare (Nashville, TN)
- …such as Mobile Heartbeat, Welch Allyn Intermittent Vital Devices, Virtual Care, Nurse Call, and Care Team Assignment integrations, among others. The primary ... support of virtual care technology at HCA facilities. This includes product management , delivery of devices for projects and acquisitions, testing updates and new… more
- Trevecca Center for Rehabilitation and Healing (Nashville, TN)
- …to optimize data quality and maximize therapist efficiency. . Managing Medicare Medical Review and Denials Management process in conjunction with the Regional ... development of the annual budget. . Appropriate and effective utilization of staff. . Managing key operations and financial...facility's Employee Handbook and as communicated by the facility's management . . Contributing to a positive work team by… more