- Community Health Systems (Franklin, TN)
- …appropriate additional documentation from the physician(s). + Escalates cases to the Utilization Review Manager and/or Physician Advisor if physicians ... of medical services and procedures in the hospital setting. Utilization review is the assessment for medical...event a facility does not have an ED Case Manager present, the UR Clinical Specialist will collaborate with… more
- Prime Therapeutics (Nashville, TN)
- …hoc reports are provided accurately and on time. + Supports the State Drug Utilization Review Boards and Pharmacy and Therapeutics (P&T) Committee. Potential pay ... every decision we make. **Job Posting Title** Pharmacist Account Manager - New York Remote **Job Description**...may vary by 8% depending on applicant location. To review our Benefits, Incentives and Additional Compensation, visit our… more
- Community Health Systems (Franklin, TN)
- **Summary:** The Manager , Strategic Sourcing works in concert with the Director, Strategic Sourcing in leading system-wide cost optimization projects. This includes ... sourcing and utilization initiatives related to supply expense reduction. The position...launch + Manage supplier performance and leads quarterly business review processes including evaluating vendor compliance with contracts and… more
- Community Health Systems (Franklin, TN)
- …appropriateness, and efficiency of medical services and procedures in the hospital setting. Utilization review is the assessment for medical necessity, both for ... to the hospital as well as continued stay. The Utilization Review Clinical Specialist supports and coordinates...and extended hospitals stays. The specialist will assist the manager in implementing process improvement plans and projects to… more
- Sharecare (Nashville, TN)
- …services + Uses technical and business development skills to increase client's utilization of current technology + Tracks, analyzes, creates, and delivers relevant ... collaboration with Director Client Success the QBR and Annual Review **Reporting** + Collaborate with the reporting team to...and dashboards and deliver monthly, quarterly and annually + Review and analyze reports for accuracy and outcomes needed… more
- Prime Therapeutics (Nashville, TN)
- …licensed functions (Pharmacy Benefit Management (PBM), Third Party Administrator, Utilization Review Organization, Business, State registrations, etc); compile ... **Job Posting Title** Senior Compliance Analyst (Interpretation and Advising) - Remote **Job Description** The Senior Compliance Analyst assists in the… more
- Prime Therapeutics (Nashville, TN)
- …and drives every decision we make. **Job Posting Title** Underwriter - Remote **Job Description** The Underwriter is responsible for assisting in the development ... response to moderate to complex RFP's + Evaluates the utilization and financial experience of customers and prospects +...ability to adjust focus **Reporting Structure** + Reports to Manager or Director in the Finance Department Potential pay… more
- Sharecare (Nashville, TN)
- …of the care enhancement program by providing telephonic care and resource utilization for members in an appropriate, efficient, and cost-effective manner while ... appropriate total healthcare management. RD colleague is supervised by an Operations Manager . All Sharecare clinicians (including the RD colleagues) are required to… more
- HCA Healthcare (Nashville, TN)
- …without reservations or limits? Our Work from Home team is looking for a Remote Manager Division Denials. HCA Healthcare is an advanced healthcare network that ... save lives across the country? Apply today to our Remote Manager Division Denials and be a...NCBON. **Preferred Certification:** Nationally accepted certification in Case Management, Utilization Review , Coding, or other denial management… more
- Elevance Health (Nashville, TN)
- …regarding case and determines appropriate area to refer or assign case ( utilization management, case management, QI, Med Review ). + Provides information ... reports and documents all actions. + Responsibilities exclude conducting any utilization management review activities which require interpretation of clinical… more
- Wolters Kluwer (Nashville, TN)
- …customer relationships to retain and grow existing commercial customer base. + Review account utilization management reporting and provide recommendations. + ... Management Executive - Field Sales Health IT** Wolters Kluwer R0046084 **LOCATION:** Remote US - Preferred locations are Washington (state), Oregon, or San Francisco… more
- United Therapeutics (Nashville, TN)
- …with superior financial performance and our communities with earth-sensitive energy utilization . Our company was founded by an entrepreneur whose daughter was ... of benefit/risk of UTC products. This position can be remote in the continental US, or in our RTP,...Act as the main point of contact and functional manager for day-to-day questions or issue escalation regarding PM… more
- Cardinal Health (Nashville, TN)
- …contributes to Cardinal Health** The DevOps engineer reports to the DevOps manager . The engineer works closely with software engineers, QA teams and other ... pipelines. + Support, maintain, and document pipelines functionality. + Assist the manager with project planning and estimation. + Perform deployments. + Integrate… more