- Sedgwick (Nashville, TN)
- …as a Great Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance RN Utilization Review **PRIMARY PURPOSE OF THE ROLE:** To utilize ... a collaborative environment, who are driven to deliver great work. + Apply your RN clinical knowledge and experience to assist in the management of complex medical… more
- Humana (Nashville, TN)
- …an impact** **Use your skills to make an impact** **Required Qualifications** + **Licensed Registered Nurse ( RN )** in the (appropriate state) with no ... caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing...in an acute care setting + Previous experience in utilization management/ utilization review for a… more
- CVS Health (Nashville, TN)
- …+ Perform medical necessity reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse with at least 1 year of experience in a hospital ... setting. + A Registered Nurse that holds an active, unrestricted...lower levels of care. + 1+ years' experience in Utilization Review . + CCM and/or other URAC… more
- Cognizant (Nashville, TN)
- …to be considered** + Educational background - Registered Nurse ( RN ) + 2-3 years combined clinical and/or utilization management experience with managed ... Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact...as well as timely filing deadlines and processes. + Review clinical denials including but not limited to referral,… more
- Gallatin Center for Rehabilitation and Healing (Gallatin, TN)
- …meaningful contributions to the rehab team conferences, patient care conferences, utilization review meetings, family conferences, and caregiver training ... . 5 days a week 37.5 - 40 hours per week Respiratory Nurse ( RN ) We are searching for a highly motivated, flexible, organized, skilled respiratory therapist… more
- HCA Healthcare (Nashville, TN)
- …treatment is reimbursed by contacting managed care organizations and completing initial utilization review . Documents in Midas as required. Involves mobile ... nurses play a vital part. We know that every nurse 's path and purpose is unique. Do you want...patients in regard to managed care organizations + Conducts utilization review for managed care cases in… more
- HealthTrust Workforce Solutions (Nashville, TN)
- …nationwide. **_JOB SUMMARY_** The Interim Leader of Case Management Services is a Registered Nurse who participates as an active administrative member of the ... to assure that the following functions of the role are completed: Utilization Review for medical necessity of admission and concurrent stay, Social Services… more
- Deloitte (Nashville, TN)
- …Bachelor's degree in nursing, medical degree, or physician assistant required + Current Registered Nurse ( RN ) license required + Certified Clinical ... nurse , physician, physician assistant, case manager, clinical documentation specialist, utilization review , informatics RN , Quality, DRG Validation and… more
- Green Hills 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 ... are seeking qualified candidates who have experience as an RN or LPN and are committed to help our...as directed by their supervisor and Administrator Qualifications: + Registered Nurse with current, active license in… more
- CenterWell (Nashville, TN)
- …community and help us put health first** Conviva Care Solutions is seeking a RN who will collaborate with other health care givers in reviewing actual and proposed ... medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that focuses on excellent… more
- HCA Healthcare (Nashville, TN)
- …and personal growth, we encourage you to apply for our Operating Room RN opening. We promptly review all applications. Highly qualified candidates will ... integrity. We care like family! Jump-start your career as an Operating Room RN today with Centennial Surgery Center. **Benefits** Centennial Surgery Center offers a… more
- HCA Healthcare (Nashville, TN)
- …At Sunrise e we support our colleagues in their positions. Join our Team as a(an) RN Coord Trauma PI PRN WFH and access programs to assist with every stage of your ... easier and more affordable to gain certifications and job skills. Apply today for our RN Coord Trauma PI PRN WFH opening and continue to learn! **Job Summary and… more
- Evolent (Nashville, TN)
- …the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. Tasks ... physician-developed medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care… more
- Highmark Health (Nashville, TN)
- …years of experience in Managed Care **LICENSES or CERTIFICATIONS** **Required** + Registered Nurse **Preferred** + Certified Medical Coder or related **SKILLS** ... and the proper action to complete the retrospective claim review with the goal of proper and timely payment...data to assure appropriate level of payment and resource utilization . It is also used to identify issues which… more
- HCA Healthcare (Nashville, TN)
- …or instruction of Clinical EHR application - Required + Currently licensed as a registered nurse or allied health professional in the state(s) in which he ... department performance in accordance with established budget, including the utilization of staffing, supplies, and equipment identifying cost reduction opportunities… more
- Evolent (Nashville, TN)
- …focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and procedures ... work with a group of nurses, providing appeal intake review for one dedicated client. They interact with coordinators...Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to company… more
- Elevance Health (Nashville, TN)
- …fraud and over- utilization by performing medical reviews via prepayment claims review and post payment auditing + Correlates review findings with appropriate ... ** Nurse Auditor Senior - Payment Integrity Complex and...responsible for identifying, monitoring, and analyzing aberrant patterns of utilization and/or fraudulent activities by health care providers through… more
- Parexel (Nashville, TN)
- …reproducible research practices like version control and literate programming. + BSN, RN , RPh, Pharm D, PA, MPH, or other applicable health professional credentials, ... solutions, and ensure high-quality, compliant data. + Use surveillance tools to review data at an aggregate level, identifying patterns or anomalies to ensure… more
- HCA Healthcare (Nashville, TN)
- …personal growth, we encourage you to apply for our Cardiology Clinical Research Nurse opening. We promptly review all applications. Highly qualified candidates ... We care like family! Jump-start your career as a Clinical Research Nurse today with TriStar Centennial Medical Center. **Benefits** TriStar Centennial Medical Center… more