- HomeSafe Alliance (Nashville, TN)
- …and motivated Assistant Claims Manager to assist in all aspects of claims management , to support and promote process improvement methodologies and best ... Raising awareness of any settlement practices, trends, or areas of concern to the Director of Claims . Responds to internal and external customer disputes and… 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)
- …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
- CVS Health (Nashville, TN)
- …clinical coverage and policies. **Primary Job Duties & Responsibilities:** Behavioral Health Medical Director + Collaborates with health plan Sr Leadership to ... and appeal system. + Leads the administration of all medical management activities of the aligned Plans....the delivery of holistic and integrated person-centered care. The Medical Director will be responsible for provider… more
- Humana (Nashville, TN)
- …us put health first** The Corporate Medical Director relies on medical background and reviews health claims and preservice appeals. The Corporate ... Medical Director reviews cases of diverse scope and complexity ranging...focused on continuously improving consumer experiences **Preferred Qualifications** + Medical /surgical utilization management review experience + Experience… more
- Norstella (Nashville, TN)
- …will be pivotal in integrating diverse data sources, including laboratory data, electronic medical records (EMR), claims data, and social determinants of health ... Senior Director , RWD Analytics and Innovation Company: Citeline Location:...of data and intelligence on clinical trials, drug treatments, medical devices and what's new in the regulatory and… more
- J&J Family of Companies (Nashville, TN)
- Director , Health Economics and Market Access - Robotics and Interventional Solutions - 2406204289W **Description** Johnson & Johnson is recruiting a Director , ... and profoundly impact health for humanity. Learn more at https://www.jnj.com/. The Director , Health Economics & Market Access for the Robotics and Interventional… more
- Cardinal Health (Nashville, TN)
- …future. The Director , Managed Care is responsible for strategy and management of managed care contracts and relationships with payers. They are responsible to ... implement strategic initiatives related to payer contracts. The Director , Managed Care contributes to practice growth and profitability by providing contracting… 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
- Evolent Health (Nashville, TN)
- …core Payer Data Warehouse datasets and Evolent Data Warehouse tables, including medical , pharmacy and ancillary claims data, membership data, clinical ... a growth mindset as we solve complex business problems. **Collaboration Opportunities** The Director , Client Analyst role will be serving as a strategic advisor to… more
- Norstella (Nashville, TN)
- Director , RWD Product Company: MMIT Location: Remote, United States Date Posted: Jul 15, 2024 Employment Type: Full Time Job ID: R-440 **Description** Why Norstella? ... assess market potential, and inform strategic decision-making. + Translate product management strategy into actionable data deliverables, guiding development of data… more
- Cracker Barrel (Lebanon, TN)
- …assures all benefits designs comply with applicable legislation and management directives. Proactively manages the benefit programs' costs, administrative processes, ... for a diverse employee population with specific experience in medical , dental, prescription drugs, leave administration, retirement programs including 401(k)… more
- Marriott (Nashville, TN)
- …States **Schedule** Full-Time **Located Remotely?** N **Relocation?** N **Position Type** Management **JOB SUMMARY** As a member of the property Human Resources ... * 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
- Evolent Health (Nashville, TN)
- …LPCs, and Clinical Reviewers. Opportunities to work collaboratively with other Utilization Management Leaders including our Associate Director and Director ... 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
- HCA Healthcare (Nashville, 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...required. The Compliance Nurse TL will be assisting the Director of Payer Analysis with training, education and performing… more
- The Cigna Group (Nashville, TN)
- …rates. + Enhance the Facility Center of Excellence Program along with with Network Medical Director and Clinical Operations which include but not limited to ... experience required. + Experience in managed care operations and facility network management including behavioral and/or medical with experience with commercial… more
- Prime Therapeutics (Nashville, TN)
- …experience conducting complex analysis on enterprise level data sets of pharmacy, claims , medical , and/or financial data + Extensive experience with analytic ... to create new business insights related to total cost management , products and services and drives recommendations for improvements...to adjust focus **Reporting Structure** + Reports to Manager, Director or Senior Director in the Consulting… more
- Wellpath (Nashville, TN)
- …a difference** The Regional Care Manager (RCM) works collaboratively with the Utilization Medical Director , Regional Medical Directors, and Site Leadership ... to overseeutilizationreview, daily care management , and care coordination for multiple sites and states....the ERMA Care ManagementSystem, andcomply withtracking and following the Medical Review procedure, including claims holds. +… more
- The Cigna Group (Nashville, TN)
- …with matrix partners to vet contract impact, including but not limited to: Claims , Medical Management , Credentialing, Legal, Medical Economics, ... Solutions team, reporting directly to the Medicare National Partnerships Director . This role is a key contributor for the...and vendor value-based network and is accountable for the management of complex contracting and network management … more
- Wellpath (Nashville, TN)
- …* Growth and training **Perks and Benefits** In addition to comprehensive benefits including medical , dental, vision, paid time off, and 401k, we foster a work, life ... Prisons(FBOP)servicesby managing andmaintainingclient accounts, including scheduling, reporting, record-keeping, and claims /invoice review.The position requires a detail-oriented individual with exceptional… more