- 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… 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… more
- Humana (Nashville, TN)
- …documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments ... community and help us put health first** The Utilization Management Registered Nurse 2 utilizes clinical nursing skills to support the coordination,… more
- Humana (Nashville, TN)
- …in an adult learning environment **OR** one (1) or more years successfully working as a Utilization Management Nurse or BH Utilization Management ... first** Humana Healthy Horizons in Virginia is seeking a Learning Facilitator/Preceptor, Utilization Management (Learning Facilitation Professional 2 ) who… more
- Humana (Nashville, TN)
- …ad hoc reports in Access and/or SQL + Graduate degree + Utilization Management Review Experience + Registered Nurse (RN) Credentials + Home Health, Durable ... caring community and help us put health first** The Compliance Professional 2 ensures compliance with governmental requirements. The Compliance Professional 2 … more
- HCA Healthcare (Nashville, TN)
- …experience with 2 years critical care or 3 years nursing experience with 2 years case management experience preferred. 3. Certification in case management ... make a real impact with your work? With over 2 ,000 sites of care and serving over 31. 2...opportunity to make a real impact. As a(an) Case Management RN you can be a part of change.… more
- HCA Healthcare (Smyrna, TN)
- …patient throughput while supporting a balance of optimal care and appropriate resource utilization . . provides case management services for both inpatient and ... compassion and comfort in our modern facility. The Registered Nurse (RN) CM is responsible for promoting patient-centered care...+ Associate Degree in Nursing or Nursing Diploma + 2 + years experience in case management OR… 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 ... continue to learn! **Job Summary and Qualifications** The Registered Nurse (RN) CM is responsible for promoting patient-centered care...in Nursing or Nursing Diploma Bachelor's Degree in Nursing 2 + years experience in case management OR… 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 ... Value Statement." Associate Degree in Nursing or Nursing Diploma Bachelor's Degree in Nursing 2 + years experience in case management OR 3+ years experience in… more
- Select Medical (Nashville, TN)
- … within the plan of care. + Demonstrates compliance with facility-wide Utilization Management policies and procedures. + Coordinates UR compliance with ... current licensure in a clinical discipline either as a Nurse or a Respiratory Therapist OR Social Work SW/MSW...what is right. The Case Manager is responsible for utilization reviews and resource management , discharge planning,… more
- Prime Therapeutics (Nashville, TN)
- …company achieving revenue goals and operational objectives. Responsible for executing utilization management programs on behalf of health plan/payor customers, ... clinical reviewer. + Practices and maintains the principles of utilization management by adhering to the company...cardholders, and pharmacies. + Escalates medical exception requests to nurse , pharmacist or physician on the utilization … more
- HCA Healthcare (Nashville, TN)
- …of nursing experience required + 2 - 4 years of relevant case management / utilization review experience required + Registered Nurse - Currently licensed ... position will provide front-line support and supervision to the Utilization Review staff to focus on initial and continued...required + InterQual Certification- IQCI or CER preferred + 2 + years of experience in InterQual preferred HCA Healthcare… more
- The Cigna Group (Franklin, TN)
- … and Coordination** 1. Participation in weekly care coordination with health plan case management as directed by market needs 2 . Referral Management Care ... in regard to their appointments, care, and overall health. 2 . Act as the liaison between the providers and...side effects, plan of care, and individualized care goals management in a culturally sensitive and acceptable manner for… more
- Elevance Health (Nashville, TN)
- …responsible for identifying, monitoring, and analyzing aberrant patterns of utilization and/or fraudulent activities by health care providers through prepayment ... + Develops, maintains and enhances the claims review process. + Assists management with developing unit goals, policies and procedures. + Investigates potential… more
- Gallatin Center for Rehabilitation and Healing (Gallatin, TN)
- …and maximize therapist efficiency. Managing Medicare Medical Review and Denials Management process in conjunction with the Regional CareRite denials support and ... therapy staff. 2 . Monitors financial performance of rehab department and effectively...in development of the annual budget. Appropriate and effective utilization of staff. Managing key operations and financial levers… more
- Vanderbilt University Medical Center (Nashville, TN)
- …Board of Nursing standards. Three great reasons to join us: - Autonomy and Utilization of Critical Skills - Teamwork that displays comradery and family center care - ... we serve. Sign On Terms: - $25,000 (taxable) over 2 years - The sign-on bonus is not applicable...Analyzes comprehensive information pertinent to the patient's care and management to determine nursing diagnosis. * Continually utilizes the… more
- Nashville Center for Rehabilitation and Healing (Nashville, TN)
- …and ensures that appropriate follow-up action is taken + Facilitates the Care Management Process engaging the resident, IDT and family in timely identification and ... basis + Responsible for timely and accurate completion of Utilization Review and Triple Check + Serves on, participates...directed by their supervisor and Administrator Qualifications: + Registered Nurse / LPN with current, active license in state… more