- Humana (Nashville, TN)
- **Become a part of our caring community and help us put health first** The Utilization Management Registered Nurse 2 utilizes clinical nursing skills to ... independent determination of the appropriate courses of action. The Utilization Management Registered Nurse...skills to make an impact** **Required Qualifications** + **Licensed Registered Nurse ( RN )** in the… more
- The Cigna Group (Nashville, TN)
- The RN Coordinator serves as the key contact point for...as needed 3) 3+ years of experience as a Registered Nurse 4) Proficient level of experience with ... and make specific recommendations based on their goals 4. Review paperwork for patients to ensure it meets all...side effects, plan of care, and individualized care goals management in a culturally sensitive and acceptable manner for… more
- Vanderbilt University Medical Center (Nashville, TN)
- …operating and capital expenditure budgets; and performing personnel administration functions. The Registered Nurse Director for the Digestive Disease Center will ... Labs. Preferred Education, Skills, and Experiences: * Master's prepared Registered Nurse is essential * 5+ years...a proposed budget (operating and capital expenditure) to a management review committee. + Evaluate organizational functions… more
- Vanderbilt University Medical Center (Nashville, TN)
- …emphasizing negative elements. **Position Qualifications:** **Responsibilities:** **Certifications:** LIC- Registered Nurse - Licensure-Others **Work ... if additional records requests or actions might be indicated * Experience/proficiency in the review and the utilization of EPIC and/or eStar including the Media… more
- Highmark Health (Nashville, TN)
- …and Sunday required in addition to 3 weekdays** This job implements effective utilization management strategies including: review of appropriateness of ... and offers interventions and/or alternatives. **ESSENTIAL RESPONSIBILITIES** + Implement care management review processes that are consistent with established… more
- Sharecare (Nashville, TN)
- …appropriate total healthcare management and ensure cost effective, appropriate resource utilization and quality outcomes. The RN is also responsible for ... and their Primary Care Provider according to the disease management program intervention guidelines. An RN is...orientation and to take the pre and posttests to review competency during orientation. Yearly competency test is required… more
- Highmark Health (Nashville, TN)
- …Remote - Part Time - Weekends Required.** This job implements the effective utilization management strategies including: review of appropriateness of health ... and offers interventions and/or alternatives. **ESSENTIAL RESPONSIBILITIES:** + Implement care management review processes that are consistent with established… more
- Ascension Health (Nashville, TN)
- **Details** + **Department:** Utilization Management + **Schedule:** Monday - Friday. 40 hours week. + **Hospital:** Ascension Saint Thomas + **Location:** ... TN market. We're looking for an experienced Director of Utilization Management to join our team! In...all clients. **Requirements** Licensure / Certification / Registration: + Registered Nurse credentialed from the Tennessee Board… more
- Humana (Nashville, TN)
- …Family Therapist **(LMFT)** , Licensed Professional Counselor **(LPC)** , Psychologist **(PhD)** , Registered Nurse **( RN )** or other professional license. + ... us put health first** Humana Healthy Horizons in Kentucky is seeking a Utilization Management Behavioral Health Professional 2 who utilizes behavioral health… more
- HCA Healthcare (Springfield, TN)
- …million dollars to charitable organizations. Apply Today! Job Summary and Qualifications The Registered Nurse ( RN ) CM is responsible for promoting ... We care like family! Jump-start your career as a RN PRN Case Management today with TriStar...supporting a balance of optimal care and appropriate resource utilization . **What you will do in this role** .… more
- HCA Healthcare (Nashville, TN)
- …with PCI, TriStar Skyline is a leading provider of emergency heart care. The Registered Nurse ( RN ) CM is responsible for promoting patient-centered care ... supporting a balance of optimal care and appropriate resource utilization . . Provides case management services for...we encourage you to apply for our Case Manager RN PRN opening. We review all applications.… more
- HCA Healthcare (Nashville, TN)
- …experience preferred + Certifications, Licenses, and other Special Requirements + Current/Active Registered Nurse ( RN ) License within practice state required ... Home Health RN Clinical Manager opening. Our team will promptly review your application. Highly qualified candidates will be contacted for interviews. **Unlock… more
- Nashville Center for Rehabilitation and Healing (Nashville, TN)
- …trends on a monthly basis + Responsible for timely and accurate completion of Utilization Review and Triple Check + Serves on, participates in, and attends ... RN MDS Director Nashville Center for Rehabilitation and...by their supervisor and Administrator MDS Director Qualifications: + Registered Nurse with current, active license in… more
- Guardian Life (Nashville, TN)
- …services. Act as a liaison between all parties required in case management to facilitate collaboration toward RTW goals. Utilization of independent ... **Position Summary** The RN Clinical Consultant serves as a clinical resource...issues, when possible, to enhance the customer experience. **Activity** Review and assess claimant subjective reports and objective medical… more
- Evolent (Nashville, TN)
- …Doing:** As a Clinical Reviewer, Nurse , you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... Clinical Reviewers are supported by Field Medical Directors (MDs) in the utilization management determination process. + Reviews charts and analyzes clinical… more
- Ascension Health (Nashville, TN)
- …specialist for staff in the areas of utilization criteria, appeal and review process, and case management system documentation. + Develop staff schedule and ... **Details** + **Department:** Case Management + **Schedule:** Full-Time, Exempt + **Hospital:** St...Registration: One or more of the following required: + Registered Nurse credentialed from the Tennessee Board… more
- Vanderbilt University Medical Center (Nashville, TN)
- …in embracing the change. **Position Qualifications:** **Responsibilities:** **Certifications:** LIC- Registered Nurse - Licensure-Others **Work Experience:** ... The Associate Nursing Officer - Neuroscience shall provide general management for the operations of a Patient Care Center...or VUMC goals. * Promote and monitor the effective utilization of the assigned space in support of the… more
- Vanderbilt University Medical Center (Nashville, TN)
- …in embracing the change. **Position Qualifications:** **Responsibilities:** **Certifications:** LIC- Registered Nurse - Licensure-Others **Work Experience:** ... research, and patient care missions of the University's Medical Center. * Review , establish, and revise policies, procedures, and standards related to all aspects… more
- The Cigna Group (Nashville, TN)
- …at home to improve quality of life, increase understanding and management of serious illness, facilitate coordination between providers, and decrease unnecessary ... includes health risk assessments, transitions of care, complex and chronic disease management , and palliative care support. We conduct in-home longitudinal care for… more
- HCA Healthcare (Nashville, TN)
- …management of Purchased Services; contract optimization, standardization and utilization of contracted Purchased Services categories; participates in development ... **Leadership** + Provides leadership in the area of expense management to contribute to the facility or IDNs overall...to give people a healthier tomorrow."- Jane Englebright, PhD, RN CENP, FAAN Senior Vice President and Chief Nursing… more