- Ascension Health (Nashville, TN)
- …. Must be located with in the TN market . We're looking for an experienced Director of Utilization Management to join our team! In this pivotal role, ... **Details** + **Department:** Utilization Management + **Schedule:** Monday -...root-cause analysis to enhance our processes. You'll collaborate with Market Care Management , Finance, CDI, and Physician… more
- Humana (Nashville, TN)
- …to the Lead Medical Director - North Central Medicaid Markets. The Medical Director conducts Utilization Management of the care received by members in ... community and help us put health first** The Medical Director relies on medical background and reviews health claims....with prior experience participating in teams focusing on quality management , utilization management , case … more
- Humana (Nashville, TN)
- … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in ... community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement...with prior experience participating in teams focusing on quality management , utilization management , case … more
- Humana (Nashville, TN)
- …. **Additional Information** Reports to a Lead Medical Director . The Medical Director conducts Utilization Management of the care received by members ... . + Prefer Medical Hematology/Oncology specialties + Prefer Medicaid experience + Utilization management experience in a medical management review… more
- Vanderbilt University Medical Center (Nashville, TN)
- …The Executive Director and Associate Operating Officer shall provide general management for the operations of the Vanderbilt Transplant Center (VTC) by providing ... The Vanderbilt Health Executive Search Team is conducting a national search for an Executive Director and Associate Operating Officer - Vanderbilt Transplant Center.… more
- HCA Healthcare (Nashville, TN)
- …**Job Summary and Qualifications** The Utilization Review Services (URS) Director of Denial Operations collaborates with Case Management , Parallon, ... & Analytics (PCA) to assess, define and execute Denials Management strategies for HCA. The Director will...Compliance policies, and quality initiatives as it relates to utilization management . + Works directly with CM… more
- Humana (Nashville, TN)
- …and interpretation skills with 5+ years of experience focusing on quality management , utilization management , discharge planning, rehabilitation services, ... Agreements, coding practices, Clinical Integration, Long Term Services & Supports, and Case Management . The Medical Director , as indicated, could need to have… more
- Vanderbilt University Medical Center (Nashville, TN)
- …Health Executive Search Team is conducting a national search for an Oncology Admin Director , of Nursing. The Oncology Admin Director , of Nursing is responsible ... mission, vision, and credo of the Vanderbilt Clinical Enterprise. The Oncology Admin Director , of Nursing will maintain the established goals of the Patient Care… more
- HCA Healthcare (Nashville, TN)
- …Do you want to join an organization that invests in you as a Director Foundational Infrastructure Services? At HCA Healthcare, you come first. HCA Healthcare has ... you have the opportunity to make a difference. We are looking for a dedicated Director Foundational Infrastructure Services like you to be a part of our team. **Job… more
- Humana (Nashville, TN)
- …At least five years of experience post-training providing clinical services . Experience in utilization management review and case management in a health ... community and help us put health first** The Behavioral Health Medical Director responsible for behavioral health care strategy and/or operations. The Behavioral… more
- Elevance Health (Nashville, TN)
- …+ Provide strategic guidance and direct support to teams involved in Utilization Management , Specialty Benefits Management , Payment Integrity, Advocacy, ... of initiatives related to the organization's product lifecycle strategy. Our ideal Director brings strong leadership, robust program management skills, and… more
- HCA Healthcare (Nashville, TN)
- …Do you want to join an organization that invests in you as a Director Clinical Pharmacy Member Support? At HealthTrust, you come first. HCA Healthcare has committed ... and you have the opportunity to make a difference. We are looking for a dedicated Director Clinical Pharmacy Member Support like you to be a part of our team. **Job… more
- GovCIO (Nashville, TN)
- **Overview** GovCIO is currently hiring for a Program Director to install and test new equipment and upgrades, installing, patching, and testing operating systems ... software, and monitoring HPC and research computing environment health and utilization . HPC and Linux systems design, engineering, administration and programming in… more
- Merck (Nashville, TN)
- …Systems Oncology, Sr. Payer & Access Strategy Lead (HSO Sr PASL) is the leadership, management , and accountability of a team of HSO PASLs. + The HSO Sr PASL holds ... and Development (R&D) division. **Responsibilities** **and Primary Activities** **Leadership and Management ** + Recruits, on-boards, trains, and manages a team of… more
- Vanderbilt University Medical Center (Nashville, TN)
- …education, and research. **Organization:** Quality Admin **Job Summary:** The Associate Director supervises, coordinates and monitors the work activity of a unit ... Quality Administration Laboratory Department is in need of a **Associate Director ** to join the team! **Department Summary:** Our new 110,000-square-foot diagnostic… more
- Prime Therapeutics (Nashville, TN)
- …our passion and drives every decision we make. **Job Posting Title** Senior Director of Underwriting - REMOTE **Job Description** The Sr. Director Underwriting ... to current clients and provide estimated savings for prospect clients + Reviews utilization , cost trends, and other assumptions that are used in pricing models. +… more
- Highmark Health (Nashville, TN)
- …:** **JOB SUMMARY** This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and ... and DOL regulations at all times. In addition to utilization review, the incumbent participates as the physician member...member of the multidisciplinary team for case and disease management . They will advise the multidisciplinary team on cases,… more
- Travelers Insurance Company (Nashville, TN)
- …skills **What is a Must Have?** + Licensed MD + 5 years clinical and utilization management experience + Certified by the American Board of Medical Specialties ... salary range provided for this position is a nationwide market range and represents a broad range of salaries...the leading edge of the P&C industry. Develop medical management strategies that help injured employees return to work… more
- Highmark Health (Nashville, TN)
- …account, and member educational initiatives that promote the Organization's Formularies, utilization management programs, and case/ disease management ... Therapeutics Committee review. + Assist in the development and implementation of utilization management programs including but not limited to: prior… more
- Evolent (Nashville, TN)
- …for operational performance of physician, nursing, and shared services staff in the utilization management value chain + Owns clinical rationale for ... lead the Clinical Operations team and work with medical director leadership to ensure consistent and efficient adjudication of...utilization management decisions made by all clinical staff + Ensures… more