- Humana (Nashville, TN)
- …of the appropriate courses of action. The Utilization Management Nurse 2/ Home Health Utilization Management : + Review cases using clinical ... part of our caring community and help us put health first** The Utilization Management ...with no disciplinary action + Clinical experience in Medicare Home Health (in the last 12 months)… more
- Humana (Nashville, TN)
- …information. **Preferred Qualifications** + BSN + 2 to 3 years of home health experience and/or utilization management experience + Experience in a ... help us put health first** Full-Time, Remote Telephonic opportunity As a Utilization Management RN working on the Home Solutions team, you will have the… 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 ... and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are varied and… more
- The Cigna Group (Franklin, TN)
- The Chief Medical Officer (CMO) Utilization Management will develop and manage efforts to improve and maintain cost and utilization trends. Responsible for ... departments of insurance, and similar accreditors/regulators for the performance of all utilization management (UM) programs across the enterprise. The CMO is… 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 ... provide a high-speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT...+ Health Plan experience + Experience in utilization management or related activities reviewing criteria… 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 ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are...a high speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT… more
- HCA Healthcare (Nashville, TN)
- …Supervises, monitors, and ensures competencies and performance of assigned home health care team(s) Supervises ongoing case management of all patients ... Home we support our colleagues in their positions. Join our Team as a(an) Home Health RN Clinical Manager and access programs to assist with every stage of… more
- The Cigna Group (Franklin, TN)
- …working with the geriatric population/ chronic condition experience 2) Home Health experience 3) Triage experience 4) Case management experience 5) Previous ... of the team to manage heath care cost and utilization **Provider Support** 1. Completes telephonic nursing assessments including...and Coordination** 1. Participation in weekly care coordination with health plan case management as directed by… more
- Vanderbilt University Medical Center (Nashville, TN)
- …Qualifications:** **Responsibilities:** **Certifications:** Certified Coding Associate - American Health Information Management Association, Certified Coding ... and guidelines to ensure accurate code selection; consider the utilization of resources during patient encounters to reflect the...Specialist - American Health Information Management Association, Certified Coding Specialist - Physician -… more
- Humana (Nashville, TN)
- …teams focusing on quality management , utilization management , case management , discharge planning and/or home health or post-acute services (such ... health insurance, other healthcare providers, clinical group practice management . + Utilization management experience...participate on project teams or organizational committees. **Work at Home Guidance** To ensure Home or Hybrid… more
- Evolent Health (Nashville, TN)
- …Director for select health plans or regions, assuming overall accountability for utilization management while working in conjunction with the SVP, CCO and/or ... **Your Future Evolves Here** Evolent partners with health plans and providers to achieve better outcomes...RBM you will be a key member of the utilization management team. We can offer you… more
- Evolent Health (Nashville, TN)
- …for selecting health plans or regions, assuming overall accountability for utilization management while working in conjunction with the Senior Medical ... **Your Future Evolves Here** Evolent partners with health plans and providers to achieve better outcomes...Reviewer you will be a key member of the utilization management team. We can offer you… more
- Evolent Health (Nashville, TN)
- …Be Doing:** As a Physician Clinical Reviewer you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... the Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. +… more
- HCA Healthcare (Nashville, TN)
- …to join an organization that invests in you as a Director of Clinical Case Management ? At HCA Healthcare, you come first. HCA Healthcare has committed up to $300 ... years. **Benefits** HCA Healthcare, offers a total rewards package that supports the health , life, career and retirement of our colleagues. The available plans and… more
- HCA Healthcare (Nashville, TN)
- …years case management experience preferred. 3. Certification in case management , nursing, or utilization review preferred. 4. InterQual experience, ... opportunity to make a real impact. As a(an) Case Management RN you can be a part of change....Center, offers a total rewards package that supports the health , life, career and retirement of our colleagues. The… more
- Evolent Health (Nashville, TN)
- …cost-effective care. **Collaboration Opportunities** : As a Radiation Technologist in the Utilization Management department, you will work closely with other ... **Your Future Evolves Here** Evolent partners with health plans and providers to achieve better outcomes...per guidelines. + Utilizing clinical guidelines approved by the Utilization Management Committee (UMC), the URN has… more
- HCA Healthcare (Nashville, TN)
- … and supply chain operations. ii) Value Analysis iii) Clinical Resource Management Program iv) Product standardization and utilization + Interacts and ... invests in you as a Senior Director Clinical Resource Management ? At HealthTrust, you come first. HCA Healthcare has...HealthTrust, offers a total rewards package that supports the health , life, career and retirement of our colleagues. The… more
- HCA Healthcare (Brentwood, TN)
- …the Occupational and Employee Health programs. The Division Director of Workforce Health and Safety facilitates change management and fosters a culture of ... labor management , including position control, scheduling excellence, productivity management , and premium pay utilization . Maintains staffing to ensure… more
- Humana (Nashville, TN)
- …teams focusing on quality management , utilization management , case management , discharge planning and/or home health or post-acute services such ... Systems, health insurance, other healthcare providers, clinical group practice management + Utilization management experience in a medical management … more
- Evolent Health (Nashville, TN)
- …Be Doing:** As a PCR, Radiation Oncology you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... of all clinical program guidelines. + Responsible for participation in the Utilization Management (UM) Committee. + Responsible for performing peer reviews… more