- HCA Healthcare (Nashville, TN)
- …**Introduction** Do you want to join an organization that invests in you as a Case Management Managed Care Consultant? At HCA Healthcare, you ... and you have the opportunity to make a difference. We are looking for a dedicated Case Management Managed Care Consultant like you to be a part of our… more
- Humana (Nashville, TN)
- …Rico. + Bachelor's Degree. + Minimum 3 years of experience working in a clinic, hospital case management , managed care / healthcare setting - working with ... duty family members; assistance with regional transfers and ensuring the receiving Managed Care Support Contractor receives the appropriate paperwork; processes… more
- Elevance Health (Nashville, TN)
- …care hospital setting, ie ER, ICU, Critical Care preferred. + Prior "telephonic" Case Management experience with a Managed Care Company preferred ... Case Manager II** is responsible for performing care management within the scope of licensure...respond to emails/instant messages in a timely fashion. + Managed Care (Home Heath, Insurance, Inpatient) experience.… more
- Humana (Nashville, TN)
- …system-related issues **Preferred Qualifications** + BSN or MSN degree + Case Management experience + Managed care experience + Certified Case ... helping adults remain independent in their homes. Our nurses are called Care Managers, because our case management services are centered on the person rather… more
- CVS Health (Nashville, TN)
- …outcomes and care planning components with appropriate referral to clinical case management or crisis intervention as appropriate. - Coordinates and ... in healthcare decision-making. - Monitoring, evaluation and documentation of care : Utilizes case management and...(Word, Excel, Outlook). **Preferred Qualifications** - Case Management and discharge planning experience. - Managed … more
- Humana (Nashville, TN)
- …and use of business metrics. + Experience working with Case managers or Care managers on complex case management , including familiarity with social ... of decisions to internal associates, and possible participation in care management . May occasionally participate in discussions...in teams focusing on quality management , utilization management , case management , discharge planning… more
- Highmark Health (Nashville, TN)
- …in Medical Management in a Health Insurance Plan; strong knowledge of managed care industry **LICENSES AND CERTIFICATION** **Required** + Medical Doctor or ... need. **Preferred** + None **SKILLS** + Critical Thinking + Case Management + Customer Service + Oral...Skills + General Computer Skills + Clinical Software + Managed Care **Language (Other than English)** None… more
- Humana (Nashville, TN)
- …and Excel **Preferred Qualifications** + Bachelor's degree - BSN + Experience with case management , discharge planning, and patient education for adult acute ... care + Managed care experience + Previous Medicare/Medicaid experience + Bilingual English/Spanish **Additional Information** + Associate will be expected to… more
- Humana (Nashville, TN)
- …and use of business metrics. + Experience working with Case managers or Care managers on complex case management , including familiarity with social ... of decisions to internal associates, and possible participation in care management . The clinical scenarios predominantly arise...in teams focusing on quality management , utilization management , case management , discharge planning… more
- Humana (Nashville, TN)
- …Substance Use Disorder Population. + Experience working with Case managers or Care managers on complex case management , including familiarity with social ... of decisions to internal associates, and possible participation in care management . The clinical scenarios arise from...in teams focusing on quality management , utilization management , case management , discharge planning… more
- Oracle (Nashville, TN)
- …is a senior customer-facing technology leader who drives technical strategy and managed services engagements for enterprise clients. As part of Oracle's Customer ... ensures that clients are able to leverage CSS' technical expertise and managed services offerings to solve complex business challenges and accelerate digital… more
- Humana (Nashville, TN)
- …prior experience participating in teams focusing on quality management , utilization management , case management , discharge planning and/or home health or ... services such as inpatient rehabilitation. **Preferred Qualifications** + Knowledge of the managed care industry including Medicare Advantage, Managed … more
- CenterWell (Bowling Green, KY)
- …review and outcomes of care analysis to determine efficiency, the efficacy of case management system as well as any other systems and process. Competently ... Case Managers and clinical staff documentation to include starts-of- care , resumption-of-cares, and re-certifications, for appropriateness of care...performs patient care assignments and staff management activities. +… more
- Valor Health (Bowling Green, KY)
- …solution focused counseling, education and referral for resources and benefits, and case management . Develops program content and organizes & leads activities ... continuity of care through the PCMM (Primary Care Management Module). + Evaluates patients records...patients utilizing rules set forth by the VA for co- managed care . + Conducts individual, group, and… more
- Valor Health (Bowling Green, KY)
- …solution focused counseling, education and referral for resources and benefits, and case management . Develops program content and organizes & leads activities ... continuity of care through the PCMM (Primary Care Management Module). + Evaluates patients records...patients utilizing rules set forth by the VA for co- managed care . + Conducts individual, group, and… more
- HCA Healthcare (Nashville, TN)
- … objectives. This role requires strong analytical leadership, a deep understanding of managed care pricing strategies, and close collaboration across PCA teams ... enterprise-including hospital, government, and regional teams-on all contracting activities with managed care organizations (MCOs) and other payers. + Develop… more
- Humana (Nashville, TN)
- …management , or similar activities **Preferred Qualifications:** + Knowledge of the managed care industry, Integrated Delivery Systems, health insurance, or ... where the analysis of situations or data requires a case by case consideration of the Medicare...+ Utilization management experience in a medical management review organization such as Medicare Advantage, managed… more
- Molina Healthcare (Bowling Green, KY)
- …ability to learn new programs. Preferred Qualifications * Experience with utilization/quality program management . * Managed care experience. * Peer review ... Healthcare Management (CPHM), Certified Professional in Health Care Quality (CPHQ), Commission for Case Manager Certification (CCMC), Case Management … more
- Molina Healthcare (Bowling Green, KY)
- …clinical practice experience, and at least 2 years as a medical director in managed care setting supporting utilization management /quality management ... expertise in performance of prior authorization, inpatient concurrent review, discharge planning, care management and interdisciplinary care team (ICT)… more
- Molina Healthcare (Bowling Green, KY)
- …ability to learn new programs. Preferred Qualifications * Experience with utilization/quality program management . * Managed care experience. * Peer review ... Healthcare Management (CPHM), Certified Professional in Health Care Quality (CPHQ), Commission for Case Manager Certification (CCMC), Case Management … more