- Humana (Nashville, TN)
- …and interpretation skills, with prior experience participating in teams focusing on quality management , utilization management , case management , ... Integrated Delivery Systems, health insurance, other healthcare providers, clinical group practice management . + Utilization management experience in a… more
- Elevance Health (Nashville, TN)
- …clinical information regarding case and determines appropriate area to refer or assign case ( utilization management , case management , QI, Med ... reports and documents all actions. + Responsibilities exclude conducting any utilization management review activities which require interpretation of clinical… more
- Humana (Nashville, TN)
- …and interpretation skills, with prior experience participating in teams focusing on quality management , utilization management , case management , ... Integrated Delivery Systems, health insurance, other healthcare providers, clinical group practice management . + Utilization management experience in a… more
- Humana (Nashville, TN)
- …and interpretation skills, with prior experience participating in teams focusing on quality management , utilization management , case management , ... Integrated Delivery Systems, health insurance, other healthcare providers, clinical group practice management . + Utilization management experience in a… more
- Humana (Nashville, TN)
- …a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, ... and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are varied and… more
- Humana (Nashville, TN)
- …**Preferred Qualifications** + Bachelor's degree in nursing (BSN) + Previous experience in Case Management , Discharge Planning or Utilization Management ... our caring community and help us put health first** The Utilization Management Nurse utilizes clinical nursing skills to support the coordination, documentation… more
- Community Health Systems (Franklin, TN)
- …The manager supports and coordinates the various aspects of the hospital's utilization management program, denials and appeals activities. Works with UR ... lending professional clinical expertise to ensure quality, timely, and cost effective utilization management to achieve optimal outcomes. The manager will be… more
- Community Health Systems (Franklin, TN)
- …clinics, imaging centers, cancer centers and ambulatory surgery centers. **Summary:** Utilization management is the analysis of the necessity, appropriateness, ... of medical services and procedures in the hospital setting. Utilization review is the assessment for medical necessity, both...care. + Documents all actions and activities in the case management software system used by the… more
- HCA Healthcare (Nashville, TN)
- …Do you want to join an organization that invests in you as a Director Case Management ? At TriStar Centennial Medical Center, you come first. HCA Healthcare has ... a difference. We are looking for a dedicated Director Case Management like you to be a...to ensure continuity of care and optimal clinical resource utilization . The Director has oversight for all aspects of… more
- United Therapeutics (Nashville, TN)
- …pulmonary diseases, and other orphan diseases. **How you'll contribute** The Associate Global PV Case Management Director plays a key role in management and ... processing for commercial UT products, including PM GSD workflows; Maintain unified PM Case Management operating procedures and monitor systems to ensure all PM… more
- HCA Healthcare (Smyrna, TN)
- **Description** Do you have the career opportunities as a Case Management RN you want in your current role? We invest in what matters most to nurses like you - ... supporting a balance of optimal care and appropriate resource utilization . What you will do in this role: +...What you will do in this role: + Provides case management services for both inpatient and… more
- Ascension Health (Nashville, TN)
- …in the areas of utilization criteria, appeal and review process, and case management system documentation. + Develop staff schedule and revises assignments ... **Details** + **Department:** Case Management + **Schedule:** Full-Time, Exempt + **Hospital:** St Thomas West + **Location:** Nashville, TN **Benefits** Paid… more
- HCA Healthcare (Nashville, TN)
- …resource utilization . What you will do in this role: + Provides case management services for both inpatient and observation patients as assigned. + ... + Makes appropriate referrals to third party payer and disease and case management programs for recurring patients and patients with chronic disease states. +… more
- Select Medical (Nashville, TN)
- …by doing what is right. The Case Manager is responsible for utilization reviews and resource management , discharge planning, treatment plan management ... documentation. You will report directly to the Director of Case Management and provide social work services,...the plan of care. + Demonstrates compliance with facility-wide Utilization Management policies and procedures. + Coordinates… more
- LifePoint Health (Pulaski, TN)
- …and discharge planning. Participate in statistical tracking and reporting of the Utilization Management metrics Facilitates appeals of denials as needed, ... for denials due to those processes within the scope of the Case Management functions. *Organizational Expectations* Actively participates in Foundation Safety… more
- Travelers Insurance Company (Nashville, TN)
- …also needed. + Drive the information advantage including data integrity, use of management information and utilization of technology and tools. + Exhibit ... not result in presenting on said losses to senior management in Claim and Business Insurance Partners. + Co-adjusts...equipment as needed. + Collaborates with other Boiler Major Case adjusters on technical issues and coverage to leverage… more
- Sunrun (Nashville, TN)
- …+ Own and develop partner or branch relationships including weekly/monthly reviews, utilization and workload management , process updates and identification and ... through our commitment to diversity, inclusion and belonging. **Overview** The O&M Case Manager is responsible for coordinating effective execution of field service… more
- Humana (Nashville, TN)
- …disciplinary action. + Three (3) or more years of professional experience in case management , in Medicare and/or Medicaid, specifically in the delivery of ... in analyzing and interpreting financial trends. + Previous experience in utilization management , discharge planning and/or home health or rehabilitation.… more
- Community Health Systems (Franklin, TN)
- …documentation from the physician(s). + Documents all actions and activities related to utilization review in the case management software system used ... **Job Summary** Utilization management is the analysis of...social workers, discharge planners, etc.) virtually, and/or through the case management software to ensure effective collaboration… more
- CenterWell (Murfreesboro, TN)
- …performance review and outcomes of care analysis to determine efficiency, the efficacy of case management system as well as any other systems and process. ... the delivery of care to all patients served by the location. Receives case referrals. Reviews available patient information related to the case , including… more