- The Cigna Group (Franklin, TN)
- The Chief Medical Officer (CMO) Utilization Management will develop and manage efforts to improve and maintain cost and utilization trends. Responsible for ... departments of insurance, and similar accreditors/regulators for the performance of all utilization management (UM) programs across the enterprise. The CMO is… more
- Humana (Nashville, TN)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are varied and… more
- HCA Healthcare (Nashville, TN)
- …or behavioral health experience required** + **1-3 years relevant case management / utilization review experience preferred** + **Must hold and maintain ... **Introduction** Do you have the career opportunities as a(an) Utilization Review Nurse BH WFH you want with your...Healthcare offers a total rewards package that supports the health , life, career and retirement of our colleagues. The… more
- Humana (Nashville, TN)
- **Become a part of our caring community and help us put health first** The Senior Project Manager manages all aspects of a project, from start to finish, so that it ... on continuously improving consumer experiences **Preferred Qualifications** + Project Management Certification + Experience in business consulting + Experience in… more
- The Cigna Group (Nashville, TN)
- …is highly desirable + Experience with healthcare data (claims, EMR) and/or Healthcare Utilization Management is highly desirable + Degree in Computer Science, ... problems that will have a positive impact on the health and well-being of many people **Qualifications** + 5+...Master's degree preferred If you will be working at home occasionally or permanently, the internet connection must be… more
- CVS Health (Nashville, TN)
- …for Aetna. Health Services strategies, policies, and programs are comprised of utilization management , quality management , network management and ... including after-hours consultation as needed. + Leads all major clinical, population health management , and quality improvement components of the aligned plan.… more
- Evolent Health (Nashville, TN)
- …Director for select health plans or regions, assuming overall accountability for utilization management while working in conjunction with the SVP, CCO and/or ... department, you will be a key member of the utilization management team. We can offer you...outcomes. **Collaboration Opportunities:** + Routinely interacts with leadership and management staff, other Medical Directors, and health … more
- Evolent Health (Nashville, TN)
- …As a Behavioral Health Field Medical Director will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... Initial Clinical Reviewers. **What you'll be doing:** + Supports pre-admission review, utilization management , and concurrent and retrospective review process. +… more
- Evolent Health (Nashville, TN)
- …for selecting health plans or regions, assuming overall accountability for utilization management while working in conjunction with the Senior Medical ... **Your Future Evolves Here** Evolent partners with health plans and providers to achieve better outcomes...Reviewer you will be a key member of the utilization management team. We can offer you… more
- HCA Healthcare (Nashville, TN)
- …to join an organization that invests in you as a Director of Clinical Case Management ? At HCA Healthcare, you come first. HCA Healthcare has committed up to $300 ... years. **Benefits** HCA Healthcare, offers a total rewards package that supports the health , life, career and retirement of our colleagues. The available plans and… more
- Evolent Health (Nashville, TN)
- …Be Doing:** As a Physician Clinical Reviewer you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... the Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. +… more
- HCA Healthcare (Nashville, TN)
- …care setting, Case Management experience preferred + Certification in Case Management , Nursing, or Utilization Review, preferred + Ability to establish and ... in their positions. Join our Team as a(an) Case Management RN and access programs to assist with every...Center, offers a total rewards package that supports the health , life, career and retirement of our colleagues. The… more
- HCA Healthcare (Nashville, TN)
- …years case management experience preferred. 3. Certification in case management , nursing, or utilization review preferred. 4. InterQual experience, ... opportunity to make a real impact. As a(an) Case Management RN you can be a part of change....Center, offers a total rewards package that supports the health , life, career and retirement of our colleagues. The… more
- Humana (Nashville, TN)
- …human services, social sciences, or health related field. + Previous experience in utilization management , discharge planning and/or home health or ... who will lead a team of nurses and behavior health professionals responsible for care management of...test as provided by the Federal Government. **Work at Home Internet Statement** To ensure Home or… more
- HCA Healthcare (Nashville, TN)
- …**Introduction** Do you have the career opportunities as an AVP Medical Device Management you want with your current employer? We have an exciting opportunity for ... Healthcare. **Benefits** HealthTrust, offers a total rewards package that supports the health , life, career and retirement of our colleagues. The available plans and… more
- Elevance Health (Spring Hill, TN)
- …associates, and may be involved in process improvement initiatives. + Submits utilization /authorization requests to utilization management with documentation ... fully integrated care plan, engaging the member's circle of support and overall management of the individuals physical health (PH)/behavioral health … more
- Humana (Nashville, TN)
- …teams focusing on quality management , utilization management , case management , discharge planning and/or home health or post-acute services such ... Systems, health insurance, other healthcare providers, clinical group practice management + Utilization management experience in a medical management … more
- HCA Healthcare (Nashville, TN)
- …patient throughput while supporting a balance of optimal care and appropriate resource utilization . Provides case management services for both inpatient and ... Do you have the career opportunities as a(an) Case Management RN PRN you want in your current role?...what matters most to nurses like you - at home , at work, and at every stage in your… more
- Humana (Nashville, TN)
- …and subpopulations. Areas of focus include Care Management , Quality Improvement, Utilization Management , Population Health , Social Determinants of ... Health , Pharmacy, Behavioral Health , Institutional Long-Term Services and Supports (LTSS), ...Organization (MCO) focusing on Medicaid clinical strategy and population health management strategy. **Alternatively** **,** 5+ years… more
- Sharecare, Inc. (Nashville, TN)
- …/ new hire plan selection, claims issues, ID card issues, grievances/appeals, utilization management (UM) status, including but not limited to medical, ... + Claims adjustments + Grievances and appeals submissions + Utilization management intake or status + Complex...Assistant + Medical Secretary/Clinic Manager + Radiology Technician + Home Health Aide + Occupational Therapist Aide… more