- HCA Healthcare (Nashville, TN)
- …**Introduction** Do you want to join an organization that invests in you as a Case Management Managed Care Consultant? At HCA Healthcare, you ... and you have the opportunity to make a difference. We are looking for a dedicated Case Management Managed Care Consultant like you to be a part of our… more
- Humana (Nashville, TN)
- …Rico. + Bachelor's Degree. + Minimum 3 years of experience working in a clinic, hospital case management , managed care / healthcare setting - working with ... duty family members; assistance with regional transfers and ensuring the receiving Managed Care Support Contractor receives the appropriate paperwork; processes… more
- Elevance Health (Nashville, TN)
- …care hospital setting, ie ER, ICU, Critical Care preferred. + Prior "telephonic" Case Management experience with a Managed Care Company preferred ... Case Manager II** is responsible for performing care management within the scope of licensure...respond to emails/instant messages in a timely fashion. + Managed Care (Home Heath, Insurance, Inpatient) experience.… more
- Humana (Nashville, TN)
- …system-related issues **Preferred Qualifications** + BSN or MSN degree + Case Management experience + Managed care experience + Certified Case ... helping adults remain independent in their homes. Our nurses are called Care Managers, because our case management services are centered on the person rather… more
- Humana (Nashville, TN)
- …and use of business metrics. + Experience working with Case managers or Care managers on complex case management , including familiarity with social ... of decisions to internal associates, and possible participation in care management . May occasionally participate in discussions...in teams focusing on quality management , utilization management , case management , discharge planning… more
- Highmark Health (Nashville, TN)
- …in Medical Management in a Health Insurance Plan; strong knowledge of managed care industry **LICENSES AND CERTIFICATION** **Required** + Medical Doctor or ... need. **Preferred** + None **SKILLS** + Critical Thinking + Case Management + Customer Service + Oral...Skills + General Computer Skills + Clinical Software + Managed Care **Language (Other than English)** None… more
- Humana (Nashville, TN)
- …and Excel **Preferred Qualifications** + Bachelor's degree - BSN + Experience with case management , discharge planning, and patient education for adult acute ... care + Managed care experience + Previous Medicare/Medicaid experience + Bilingual English/Spanish **Additional Information** + Associate will be expected to… more
- Humana (Nashville, TN)
- …and use of business metrics. + Experience working with Case managers or Care managers on complex case management , including familiarity with social ... of decisions to internal associates, and possible participation in care management . The clinical scenarios predominantly arise...in teams focusing on quality management , utilization management , case management , discharge planning… more
- Humana (Nashville, TN)
- …Substance Use Disorder Population. + Experience working with Case managers or Care managers on complex case management , including familiarity with social ... of decisions to internal associates, and possible participation in care management . The clinical scenarios arise from...in teams focusing on quality management , utilization management , case management , discharge planning… more
- Humana (Nashville, TN)
- …prior experience participating in teams focusing on quality management , utilization management , case management , discharge planning and/or home health or ... services such as inpatient rehabilitation. **Preferred Qualifications** + Knowledge of the managed care industry including Medicare Advantage, Managed … more
- CenterWell (Murfreesboro, TN)
- …review and outcomes of care analysis to determine efficiency, the efficacy of case management system as well as any other systems and process. Competently ... Case Managers and clinical staff documentation to include starts-of- care , resumption-of-cares, and re-certifications, for appropriateness of care...performs patient care assignments and staff management activities. +… more
- HCA Healthcare (Nashville, TN)
- … objectives. This role requires strong analytical leadership, a deep understanding of managed care pricing strategies, and close collaboration across PCA teams ... enterprise-including hospital, government, and regional teams-on all contracting activities with managed care organizations (MCOs) and other payers. + Develop… more
- Humana (Nashville, TN)
- …management , or similar activities **Preferred Qualifications:** + Knowledge of the managed care industry, Integrated Delivery Systems, health insurance, or ... where the analysis of situations or data requires a case by case consideration of the Medicare...+ Utilization management experience in a medical management review organization such as Medicare Advantage, managed… more
- Green Hills Center for Rehabilitation and Healing (Nashville, TN)
- …an understanding of MDS requirements related to varied payers including Medicare, Managed Care and Medicaid + Ensures timely electronic submission of ... regulations and company policy and procedures. Acts as in-house case manager by considering all aspects of the residents...that appropriate follow-up action is taken + Facilitates the Care Management Process engaging the resident, IDT… more
- Ford Motor Company (Nashville, TN)
- …Mesh, Anthos, Pub/Sub, Dataflow, Cloud Scheduler, Bigtable, AlloyDB and other managed services. + Possess experience with Google Cloud infrastructure provisioning ... including VPC, Subnet, Gateway, Security groups, managed services, Kubernetes Cluster etc. + Possess expertise with automating Infrastructure as Code using… more
- HCA Healthcare (Nashville, TN)
- …cycle operations experience strongly preferred. + Minimum 5 years health care management /leadership experience required. + Experience leading large organizations ... clinical documentation improvement, practice coding processes, and division relationship management as applicable. The RCOM assists the Regional Coding Operations… more
- Western Digital (Nashville, TN)
- …emerging storage business models. The ideal candidate will bring a management consulting background with experience advising technology companies on platform ... models). + Assess market opportunities in Software-Defined Storage (SDS), storage management platforms, data orchestration, and tiered storage solutions. + Evaluate… more
- HCA Healthcare (Nashville, TN)
- …practices. + Maintains/obtains professional competence and knowledge of healthcare economics, managed care /reimbursement issues in the industry. + Attends ... auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more. + Free counseling… more
- HCA Healthcare (Nashville, TN)
- …private payer regulations and processes. You will possess a thorough understanding of managed - care concepts and length-of-stay management relating to patient ... in this role: + You will work collaboratively with RN case managers, acute care nurses, physicians, insurance companies, and other staff members to proactively… more
- HCA Healthcare (Nashville, TN)
- …private payer regulations and processes. You will possess a thorough understanding of managed - care concepts and length-of-stay management relating to patient ... in this role: + You will work collaboratively with RN case managers, acute care nurses, physicians, insurance companies, and other staff members to proactively… more