- Humana (Nashville, TN)
- …documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are ... a part of our caring community and help us put health first** The Utilization Management Registered Nurse 2 utilizes clinical nursing skills to support the… more
- Lincoln Financial Group (Nashville, TN)
- …Experience and/or proficiency with Disability Management (STD/LTD) knowledge, Workers Compensation, Utilization Review and/or nurse case management ... Role at a Glance** We are excited to bring on a highly motivated Nurse Disability Consultant to our clinical organization. This position will be responsible for… more
- Centene Corporation (Nashville, TN)
- …and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and ... 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive… more
- ChenMed (Nashville, TN)
- …explain nurse practitioner role. + Facilitates patient/family conferences to review treatment goals, optimize resource utilization , provide family education ... **Job Requirements** The Nurse Practitioner must demonstrate the ability to function...management programs, clinical meetings and other meetings. The Nurse Practitioner will adhere to strict departmental goals/objectives, standards… more
- The Cigna Group (Nashville, TN)
- …at home to improve quality of life, increase understanding and management of serious illness, facilitate coordination between providers, and decrease unnecessary ... includes health risk assessments, transitions of care, complex and chronic disease management , and palliative care support. We conduct in-home longitudinal care for… more
- Vanderbilt University Medical Center (Nashville, TN)
- …if additional records requests or actions might be indicated * Experience/proficiency in the review and the utilization of EPIC and/or eStar including the Media ... the VPEC OHO Clinic * Comfortable with the clinical review of testing results and visit plans to determine...tab, Care Everywhere, StarPanel, dot phrases, message basket management , and sending communications * Experience/proficiency in the use… more
- Sedgwick (Nashville, TN)
- …and consult review ; and two (2) years of experience in daily application of nurse auditing, utilization review and bill review . **Skills & ... Great Place to Work(R) Most Loved Workplace(R) Forbes Best-in-State Employer RN Bill Review **PRIMARY PURPOSE** **:** To review hospital and professional medical… 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...path, we encourage you to apply for our Case Management RN PRN opening. We review all… more
- LifePoint Health (Gallatin, TN)
- … management program. Ensure staff competencies in all areas of care management to include utilization review , transition/discharge planning, social work ... current upon hire *Required Skills* Licenses: State of Tennessee or Multi-State Registered Nurse licensure - Required Certification in Case Management such as… 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 ... continue to learn! **Job Summary and Qualifications** The Registered Nurse (RN) CM is responsible for promoting patient-centered care...you, we encourage you to apply for our Case Management RN opening. Our team will promptly review… 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 ... Centennial Medical Center! **Job Summary and Qualifications** The Registered Nurse (RN) CM is responsible for promoting patient-centered care...path, we encourage you to apply for our Case Management RN PRN opening. We review all… more
- Highmark Health (Nashville, TN)
- …Inc. **Job Description :** **JOB SUMMARY** This job implements the effective utilization management strategies including: review of appropriateness of ... and offers interventions and/or alternatives. **ESSENTIAL RESPONSIBILITIES:** + Implement care management review processes that are consistent with established… more
- Vanderbilt University Medical Center (Nashville, TN)
- …- Neuroscience. The Associate Nursing Officer - Neuroscience shall provide general management for the operations of a Patient Care Center by providing administrative ... * Lead activities related to performance, improvement, and risk management programs in order to establish and meet clinical...or VUMC goals. * Promote and monitor the effective utilization of the assigned space in support of the… more
- HCA Healthcare (Hendersonville, TN)
- …effective labor management , including position control, scheduling excellence, productivity management , and premium pay utilization to maintain staffing to ... + Bachelor's Degree required, Master's Degree preferred + Current licensure as a Registered Nurse (RN) in the state of practice required + 1-3 years of related… more
- Gallatin Center for Rehabilitation and Healing (Gallatin, TN)
- …to optimize data quality and maximize therapist efficiency. Managing Medicare Medical Review and Denials Management process in conjunction with the Regional ... of Rehabilitation in development of the annual budget. Appropriate and effective utilization of staff. Managing key operations and financial levers to achieve budget… more
- HCA Healthcare (Nashville, TN)
- …and performance of assigned home health care team(s) Supervises ongoing case management of all patients ensuring an accurate evaluation and treatment plan, ... clinicians regarding deficiencies or OASIS corrections (with feedback from Quality Review Specialist) to ensure the medical records reflect compliance with medical… more
- HCA Healthcare (Nashville, TN)
- …onsite assessments of focused topics within HCA Healthcare hospitals/ASCs including credentialing, utilization management , peer review , medical staff and ... guidance to division vice president, quality or director, quality and risk management . Up to 75% TRAVEL REQUIRED Major Responsibilities * Individual serves as… more
- Nashville Center for Rehabilitation and Healing (Nashville, TN)
- …trends on a monthly basis + Responsible for timely and accurate completion of Utilization Review and Triple Check + Serves on, participates in, and attends ... and ensures that appropriate follow-up action is taken + Facilitates the Care Management Process engaging the resident, IDT and family in timely identification and… more