- Humana (Nashville, TN)
- …help us put health first** Humana Healthy Horizons in Kentucky is seeking a Utilization Management Behavioral Health Professional 2 who utilizes ... and communication of medical services and/or benefit administration determinations. The Utilization Management Behavioral Health Professional… more
- Highmark Health (Nashville, TN)
- …in addition to 3 weekdays** This job implements effective utilization management strategies including: review of appropriateness of health care services, ... utilization , identification of opportunities for referral to a Health Coach/case management , and identification and resolution...position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of… more
- HCA Healthcare (Nashville, TN)
- …services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed ... 740+ bed comprehensive facility. We offer medical and surgical programs. These include behavioral health and 24-hour emergency. These also include heart and… more
- Elevance Health (Nashville, TN)
- …A proud member of the Elevance Health family of companies, Carelon Behavioral Health , formerly Beacon Health Options, offers superior clinical mental ... preferred. + Extensive orthopedic surgery experience preferred. + Experience with utilization management , especially with CMS guidelines preferred. For… more
- Highmark Health (Nashville, TN)
- …:** **JOB SUMMARY** This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and ... (DO) **Substitutions** + None **Preferred** + Master's Degree in Business Administration/ Management or Public Health **EXPERIENCE** **Required** + 5 years… more
- HCA Healthcare (Nashville, TN)
- …services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed ... organization that invests in you as a Director Case Management ? At TriStar Centennial Medical Center, you come first....Center offers a total rewards package that supports the health , life, career and retirement of our colleagues. The… more
- HCA Healthcare (Nashville, TN)
- …services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed ... Do you have the career opportunities as a Case Management RN you want in your current role? We...Center, offers a total rewards package that supports the health , life, career and retirement of our colleagues. The… more
- Elevance Health (Nashville, TN)
- … health care program in which members' needs are identified, including physical health , behavioral health , social services for a special product/programs ... Skills, Capabilities and Experiences:** Service delivery coordination, discharge planning, or behavioral health experience in a managed care setting preferred.… more
- CenterWell (Nashville, TN)
- …Care/Case Management is responsible for managing a team of nurses, community health workers, and behavioral health resources who engage high risk/high ... part of our caring community and help us put health first** The Manager, Care Management leads...well-being. Our integrated care teams, which include physicians, nurses, behavioral health specialists and more, spend up… more
- Highmark Health (Nashville, TN)
- …, physician practice management or clinical operations, ancillary provider management or clinical operations, and/or health insurance) with significant ... knowledge of and experience with various care delivery models + Experience in health plan provider network performance management , care/case management ,… more
- HCA Healthcare (Nashville, TN)
- …services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed ... role:** Supervises, monitors, and ensures competencies and performance of assigned home health care team(s) Supervises ongoing case management of all patients… more
- Highmark Health (Nashville, TN)
- …(NCQA), Utilization Review Accreditation Committee (URAC), Pennsylvania Department of Health , Department of Labor, the Center for Medicare and Medicaid Services ... review and make determinations regarding physician reviewer assignments for medical management decisions. Cases requiring physician review are provider and member… more
- LifePoint Health (Brentwood, TN)
- …Lifepoint's healthcare delivery network.Our network includes 60 community hospitals, 60 rehabilitation/ behavioral health hospitals, and 250 additional sites of ... the clinical departments by planning, supporting, and implementing information systems for Health Information Management . The Analyst - Business Systems acts as… more
- Elevance Health (Nashville, TN)
- …identification, evaluation, coordination and management of member's needs, including physical health , behavioral health , social services and long term ... care team, to ensure cost effective and efficient utilization of health benefits. + Decision making...Office (Excel, Word, Outlook, etc.) strongly preferred. + Case management experience strongly preferred. + Home health … more
- Highmark Health (Nashville, TN)
- …to deliver financial results to the Enterprise. **ESSENTIAL RESPONSIBILITIES** + Perform management responsibilities to include, but are not limited to: involved in ... termination decisions, coaching and development, rewards and recognition, performance management and staff productivity.Plan, organize, staff, direct and control the… more
- Highmark Health (Nashville, TN)
- …resource efficiency. + Proposes ideas, designs, and solutions to lead engineers and management to further cloud service utilization and optimization. + Develops ... **Company :** Highmark Health **Job Description :** **JOB SUMMARY** This job...of action. + Level 3 Incident, problem and change management as it pertains to the responsibilities of the… more
- Highmark Health (Nashville, TN)
- …sales revenue and expanding market share through new client acquisition and relationship management . The ideal candidate will have a strong background in B2B sales, ... as: Financial Services, Utilities, Property and Casualty Insurance + CRM utilization **Preferred** + Transactional print and mail and digital delivery experience… more
- HCA Healthcare (Hermitage, TN)
- …services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed ... team. **Benefits** HCA Healthcare, offers a total rewards package that supports the health , life, career and retirement of our colleagues. The available plans and… more
- HCA Healthcare (Nashville, TN)
- …services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed ... clinical education and staff development, operational optimization of drug products, management of appropriate drug utilization through clinical pathway… more
- HCA Healthcare (Nashville, TN)
- …services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed ... 740+ bed comprehensive facility. We offer medical and surgical programs. These include behavioral health and 24-hour emergency. These also include heart and… more