- 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 ... **Become a part of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement… more
- Humana (Nashville, TN)
- …community and help us put health first** The Medical Director relies on medical background and reviews health claims . The Medical Director work ... Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an… more
- Humana (Nashville, TN)
- … management or utilization management . **Additional Information** Reports to a Lead Medical Director . The Medical Director conducts Utilization ... a part of our caring community and help us put health first** The Medical Director relies on medical background and reviews preauthorization requests… more
- Merck (Nashville, TN)
- **Job Description** **Role Summary** The Regional Medical Scientific Director is a credentialed (ie, PhD, PharmD, DNP, MD) therapeutic and disease expert who ... SLs, including questions about Company products. The work of an Regional Medical Scientific Director is aligned to: Scientific Exchange, Research, Scientific… more
- Western Digital (Nashville, TN)
- …of action. + Develop, formulate and coordinate property and casualty insurance claims control function at all locations. + Continue review of existing safety, ... environment, loss prevention, employment and security programs as related to the management of risk or accidental loss. + Maintain historical record of all losses,… more
- Ascension Health (Nashville, TN)
- …Ascension Saint Thomas hospitals throughout the TN market. We're looking for an experienced Director of Utilization Management to join our team! In this pivotal ... optimize patient care, and partner with the National Senior Director of UM to align on organizational goals. Ready...within the insurance plan. + Ensure integration of utilization management functions with network strategy and claims … more
- HomeSafe Alliance (Nashville, TN)
- **Title:** Director of International, Global Household Goods Moving Services **_HomeSafe Alliance_** is the single global household goods movement manager of over ... the Role** HomeSafe Alliance is seeking a highly skilled and motivated Director of International, Household Goods Moving Services to drive optimization and improve… more
- Baylor Scott & White Health (Nashville, TN)
- … claims data to uncover trends and assist in managing and understanding incurred medical and pharmacy cost. - The Director will design, develop, and support ... **Position Overview:** Reporting to the VP, Value-based Care Analytics, the Director of Healthcare Economics and Trend Analytics will support the Baylor Scott &… more
- Humana (Nashville, TN)
- …our caring community and help us put health first** The Actuarial Director , Analytics/Forecasting analyzes and forecasts financial, economic, and other data to ... short, medium and long-term financial and competitive position. The Director , Actuarial Analytics/Forecasting requires an in-depth understanding of how organization… more
- Nabholz Construction Serv (Franklin, TN)
- …teams with the proper reporting and classification of incidents and provides advice on claims management . + Work with project and specialty group teams to ... services. We are proud to offer you : + Medical , Dental and Vision Care + 401(k) Retirement Savings...Deposit + Wellness Program with Incentives Summary: Regional Safety Director carries out a wide range of functions in… more
- Takeda Pharmaceuticals (Nashville, TN)
- …to bring life-changing therapies to patients worldwide. Join Takeda as Associate Director , Global Labeling Lead where you will be responsible for the development ... guidance. **How you will contribute:** With guidance from leadership: Management of Labeling Cross-Functional Teams + Independently leads Labeling cross-functional… more
- Elevance Health (Nashville, TN)
- …policies or new business. May include oversight of multiple functions within claims , customer service, enrollment and billing, document management , mail ... Monday - Friday; 8:00am - 5:00pm CT **Location:** On-site; Nashville, TN The ** Director I Customer Care** is responsible for directing an area responsible for… more
- Wellpath (Nashville, TN)
- …Risk Management department, including a specialized correctional health clinical claims director nurse, to develop a comprehensive risk management ... to the Chief Legal Officer, this role oversees the Claims Management team, the company's insurance portfolio,...handling medical malpractice litigation and professional liability claims management is a requirement of the… more
- Marriott (Nashville, TN)
- …**Schedule** Full Time **Located Remotely?** N **Position Type** Management **JOB SUMMARY** As a member of the property ... * High school diploma or GED; 3 years experience in the human resources, management operations, or related professional area. OR * 2-year degree from an accredited… more
- HomeSafe Alliance (Nashville, TN)
- **Title:** Operations Supervisor - Move Management (International Alaska) **_HomeSafe Alliance_** is the single global household goods movement manager of over ... directly or through PPM options + Provide consolidated oversight and management of coordinators under supervision + Monitor international operations performing… more
- Evolent (Nashville, TN)
- …and LPCs, Clinical Reviewers. Opportunities to work collaboratively with other Utilization Management Leaders including our Director may also be available. ... culture. **What You'll Be Doing:** The **Coordinator, Intake Utilization Management ** at Evolent will serve as a point of...also works with our clinical team, which includes our medical reviews: LVNs, LPNs, and RNs along with our… more
- Prime Therapeutics (Nashville, TN)
- …+ Experience writing SQL queries + Prior PBM experience or experience working with medical claims , pharmacy claims , healthcare and/or benefits data + ... as assigned **Minimum Qualifications** + Bachelor's Degree in Business Administration, Management , Economics or related area of study, or equivalent combination of… more
- Mathematica (Nashville, TN)
- …or APCD claims data; EHR and/or HIE data; healthcare informatics; medical coding). * Ability to describe difficult technical problems and solutions to a ... data pipelines and analyses involving large administrative data sources such as state Medicaid claims and APCDs, as well as clinical data sources such as EHRs and… more
- SitusAMC (Nashville, TN)
- …team! This role is responsible for aligning business goals with employees and management . The position should anticipate HR needs in a proactive manner and ... communicate these requirements and potential solutions to the management team. This position is the HR point of contact for management and employees for their… more
- HCA Healthcare (Brentwood, TN)
- …and retirement of our colleagues. The available plans and programs include: + Comprehensive medical coverage that covers many common services at no cost or for a low ... as well as free telemedicine services and free AirMed medical transportation. + Additional options for dental and vision...require an RNs clinical expertise and that are delaying claims from processing in the Patient Accounting and/or Relay… more