- Humana (Nashville, TN)
- …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 ... and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are varied and… 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 preferred ... We are excited to bring on a highly motivated Nurse Disability Consultant to our clinical organization. This position...in a career at Lincoln, we encourage you to review our current openings and apply on our website.… more
- Humana (Nashville, TN)
- …through excellent written and verbal communication **Preferred Qualifications** + Registered Nurse + Experience in Medicare Utilization Management + Project ... are addressed. They will work closely with established functions inside utilization management (Medical Director, clinician decision making teams, quality audits,… more
- Humana (Nashville, TN)
- …reports in Access and/or SQL + Graduate degree + Utilization Management Review Experience + Registered Nurse (RN) Credentials + Home Health, Durable Medical ... Equipment, and/or Skilled Nursing Facility Experience **Additional Information** **Scheduled Weekly Hours** 40 **Pay Range** The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the… 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...quality management programs, clinical meetings and other meetings. The Nurse Practitioner will adhere to strict departmental goals/objectives, standards… more
- The Cigna Group (Nashville, TN)
- …with chronic illnesses in an effort improve clinical outcomes and decrease utilization . We provide physical, emotional, and spiritual support for patients who are ... facing life-threatening illnesses. We are currently seeking nurse practitioners who are passionate about serious illness care...the community PCP. + Provider will be responsible to review patient records for past and present health issues,… 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 ... claims review , post payment auditing, and provider record review...goals, policies and procedures. + Investigates potential fraud and over- utilization by performing the most complex medical reviews via… more
- Vanderbilt University Medical Center (Nashville, TN)
- …research, and patient care missions of the University's Medical Center. * Review , establish, and revise policies, procedures, and standards related to all aspects ... Create programs to meet the future market requirements. * Monitor and review departmental performance of productivity targets. * Implement changes for improvement… more
- Vanderbilt University Medical Center (Nashville, TN)
- …with the Division, Department, or VUMC goals. * Promote and monitor the effective utilization of the assigned space in support of the PCC's goals. * Ensure the ... Meet at least monthly with the members of the PCC leadership team to review clinical performance data. * Compliance and Regulatory * Review , approve,… more
- HCA Healthcare (Nashville, TN)
- …step in your career path, we encourage you to apply for our Operating Room Nurse - Float Pool opening. We review all applications. Qualified candidates will be ... you have the career opportunities as an Operating Room Nurse - Float Pool you want in your current...the instrument and equipment set-up for your OR, including utilization of preference cards and ability to anticipate your… more
- HCA Healthcare (Nashville, TN)
- …management experience preferred. 3. Certification in case management, nursing, or utilization review preferred. 4. InterQual experience, preferred. 5. Ability ... location._** It is an exciting time to be a nurse at HCA Healthcare! Come unlock your career potential...supporting a balance of optimal care and appropriate resource utilization . II. **POSITION QUALIFICATIONS:** 1. Bachelor's prepared RN with… more
- HCA Healthcare (Hendersonville, TN)
- …+ 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 ... including position control, scheduling excellence, productivity management, and premium pay utilization to maintain staffing to ensure appropriate patient care. +… more
- Houston Methodist (Nashville, TN)
- …caring for adults in an acute care hospital setting is required; coding and utilization review experience preferred + For Medical School graduate - One year ... **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure and/or Compact State Licensure...Licensure within 60 days **OR** + RN-Temp - Registered Nurse - Temporary State Licensure within 60 days +… more
- HCA Healthcare (Smyrna, TN)
- …care. We offer compassion and comfort in our modern facility. The Registered Nurse (RN) CM is responsible for promoting patient-centered care by coordinating the ... supporting a balance of optimal care and appropriate resource utilization . . provides case management services for both inpatient...and Value Statement." + Currently licensed as a Registered Nurse in the state(s) of practice according to law… more
- HCA Healthcare (Nashville, TN)
- …clinicians regarding deficiencies or OASIS corrections (with feedback from Quality Review Specialist) to ensure the medical records reflect compliance with medical ... necessity, homebound status, visit utilization , and documentation of individualized patient assessment and transition (discharge) planning. Reviews agency assigned… more
- HCA Healthcare (Smyrna, TN)
- …Apply Today! **Job Summary and Qualifications** We are seeking an Operating Room Nurse for our ambulatory surgery center who demonstrates the values of our company ... role: + Oversee the instrument and equipment set-up for your OR, including utilization of preference cards and ability to anticipate your surgeons needs + Coordinate… 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 CareRite ... 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)
- …TriStar Centennial Medical Center! **Job Summary and Qualifications** The Registered Nurse (RN) CM is responsible for promoting patient-centered care by coordinating ... supporting a balance of optimal care and appropriate resource utilization . Provides case management services for both inpatient...apply for our Case Management RN PRN opening. We review all applications. Qualified candidates will be contacted by… more
- Cardinal Health (Nashville, TN)
- …plans and meet or exceed cost, quality, clinical and utilization standards, and performance measures. + Oversees Identification, development, implementation, ... (such as patient access & registration, prior auth, medical Records, scheduling, nurse navigation, scribe etc.) + Manages development and maintenance of operational… more
- HCA Healthcare (Nashville, TN)
- …assessments of focused topics within HCA Healthcare hospitals/ASCs including credentialing, utilization management, peer review , medical staff and board bylaws, ... (hospital department manager or director experience and success) * Registered nurse , registered pharmacist, a laboratory specialist to include a medical technologist… more