- Cognizant (Nashville, TN)
- …you need to have to be considered** + Educational background - Registered Nurse (RN) + 2-3 years combined clinical and/or utilization management ... Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact...care revenue cycle or clinic operations + Experience in utilization management to include Clinical Appeals and… more
- Community Health Systems (Franklin, TN)
- **Job Summary** The Remote PRN Clinical Utilization Review Specialist is responsible for evaluating the necessity, appropriateness, and efficiency of hospital ... and collaborates with healthcare providers to facilitate efficient patient care. The Clinical Utilization Review Specialist monitors adherence to hospital … 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 ... independent determination of the appropriate courses of action. The Utilization Management Nurse 2 uses clinical...skills to make an impact** **Required Qualifications** + **Licensed Registered Nurse (RN)** in the (appropriate state)… more
- CVS Health (Nashville, TN)
- …+ Perform medical necessity reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse with at least 1 year of experience in a hospital ... is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that...setting. + A Registered Nurse that holds an active, unrestricted… more
- Select Medical (Nashville, TN)
- …mechanical ventilation liberation rates. **Qualifications** Minimum requirements: + Permanent State Registered Nurse License and Certificate of Authority. + ... such as medication errors, falls, and hospital-acquired pressure ulcers. Champions nurse -driven protocols to decrease urinary catheter utilization rates and… more
- Vanderbilt University Medical Center (Nashville, TN)
- …emphasizing negative elements. **Position Qualifications:** **Responsibilities:** **Certifications:** LIC- Registered Nurse - Licensure-Others **Work ... patients and families from the beginning - Autonomy and Utilization of Critical Skills - Teamwork that displays comradery...of the healthcare team. Has experience in gathering pertinent clinical data that aid in referral, treatment, or other… more
- Evolent (Nashville, TN)
- …+ Performs other duties as assigned. **The Experience You'll Need (Required):** + Registered Nurse or Licensed Practical/Vocational Nurse with a current, ... for the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals.… more
- Deloitte (Nashville, TN)
- …certification a plus (CRC, CCA, CCS-P, CCS, CPC, CDIP, CCM) + Experience as clinical registered nurse , physician, physician assistant, case manager, ... or physician assistant required + Current Registered Nurse (RN) license required + Certified Clinical ...clinical documentation specialist, utilization review, informatics RN, Quality, DRG Validation and health… more
- CVS Health (Nashville, TN)
- …in state of residence - 3+ years of acute experience as a Registered Nurse - 1+ years of Utilization Management experience - Must have experience using MS ... Works closely with functional area management to ensure consistency in clinical interventions supporting our members. Accountable for meeting the financial,… more
- Philips (Nashville, TN)
- …imaging equipment etc) with clinical experience as Radiologic Technologist (RT) or Registered Nurse (RN) highly preferred. + Experience in healthcare (in the ... **Sales Support, Clinical Specialist - FORS (West/National Travel)** In this...to effectively manage assigned accounts in terms of driving utilization , customer relationship management, problem resolution, etc. + You… more
- Vanderbilt University Medical Center (Nashville, TN)
- …emphasizing negative elements. **Position Qualifications:** **Responsibilities:** **Certifications:** LIC- Registered Nurse - Licensure-Others **Work ... and research. **Organization:** MCJCHV Nursing Education **Job Summary:** The clinical education facilitator, PRN participates in the assessment, planning,… more
- HCA Healthcare (Nashville, TN)
- …evaluation and utilize adult learning principles - Required + Currently licensed as a registered professional nurse in the state(s) in which he or she practices, ... area. This includes educational aspects of orientation and onboarding of clinical employees, clinical professional development, and development of education… more
- Vanderbilt University Medical Center (Nashville, TN)
- …research. **Organization:** Neonatal/Ped Trnsprt Cohort 10 **Job Summary:** JOB SUMMARY The Registered Nurse provides critical care to neonatal and pediatric ... instead of emphasizing negative elements. **Position Qualifications:** **Responsibilities:** **Certifications:** LIC- Registered Nurse - Licensure-Others **Work Experience:** Relevant… more
- HCA Healthcare (Nashville, TN)
- …Nursing, Health Administration, or Business Administration, preferred + Either Registered Nurse (RN) licensure , Licensed Clinical Social Worker (LCSW) or ... actively engaging interdisciplinary teams and external stakeholders. The Director is a registered nurse with responsibility for all operational aspects of the… more
- Highmark Health (Nashville, TN)
- …years of experience in Managed Care **LICENSES or CERTIFICATIONS** **Required** + Registered Nurse **Preferred** + Certified Medical Coder or related **SKILLS** ... 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
- Adecco US, Inc. (Nashville, TN)
- …or Business Administration preferred + Current licensure as one of the following required: + Registered Nurse (RN) + Licensed Clinical Social Worker (LCSW) + ... interdisciplinary teams and external partners to promote continuity of care, optimize clinical resource utilization , and achieve key performance outcomes. This… more
- Green Hills Center for Rehabilitation and Healing (Nashville, TN)
- …as required, and as directed by their supervisor and Administrator Qualifications: + Registered Nurse with current, active license in state of practice. + ... that allow capture of resources provided on the MDS, clinical trends that impacts resident care, and any additional...basis + Responsible for timely and accurate completion of Utilization Review and Triple Check + Serves on, participates… more
- Community Health Systems (Franklin, TN)
- …needed per Director invite **Qualifications** + Required Education: Registered Nurse + Preferred Education: BSN, MSN, Clinical Informatics **Required ... in an Acute Care hospital minimum 1-2 years + Clinical Case Management 1-2 years + Utilization Review Experience **Preferred Experience:** + 2-5 years + Cerner… more