- CVS Health (Nashville, TN)
- …we do it all with heart, each and every day. **Position Summary:** The ** Utilization Management Clinical Nurse Consultant - Prior Authorization** utilizes ... Time_ ). + Previous experience with prior authorization. + Previous experience with utilization management . + Previous experience in an acute care setting. +… more
- CVS Health (Nashville, TN)
- …And we do it all with heart, each and every day. **Position Summary** Utilization Management is a 24/7 operation and work schedules will include weekends, ... Qualifications** - 2+ years of experience as a Registered Nurse in adult acute care/critical care setting - Must...and unrestricted RN licensure in state of residence - Utilization Management is a 24/7 operation and… more
- CenterWell (Nashville, TN)
- …RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability ... Therapy, DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare… more
- Humana (Nashville, TN)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- Cognizant (Nashville, TN)
- …background - Registered Nurse (RN) + 2-3 years combined clinical and/or utilization management experience with managed health care plan + 3 years' experience ... Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced...care revenue cycle or clinic operations + Experience in utilization management to include Clinical Appeals and… more
- Sedgwick (Nashville, TN)
- …staff and claims examiners regarding treatment issues. + Performs treatment utilization management reviews. + Maintains client's privacy and confidentiality; ... Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance RN Utilization Review **PRIMARY PURPOSE OF THE ROLE:** To utilize evidence-based tools to… more
- CVS Health (Nashville, TN)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... Abuse or Maternity/ Obstetrics experience. **Preferred Qualifications** + 1+ years' Case Management experience or discharge planning, nurse navigator or nurse… more
- Evolent (Nashville, TN)
- …Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. Tasks are performed ... medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care across the continuum… more
- Evolent (Nashville, TN)
- …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and ... **What You Will Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to company policies and… more
- Gallatin Center for Rehabilitation and Healing (Gallatin, TN)
- Schedule . 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 ... meaningful contributions to the rehab team conferences, patient care conferences, utilization review meetings, family conferences, and caregiver training sessions. +… more
- Vanderbilt University Medical Center (Nashville, TN)
- …to impact pediatric patients and families from the beginning - Autonomy and Utilization of Critical Skills - Teamwork that displays comradery and family center care ... * Analyzes comprehensive information pertinent to the patient's care and management to determine nursing diagnosis. * Continually utilizes the nursing process… more
- HealthTrust Workforce Solutions (Nashville, TN)
- …budget and resource management , cost control, contract compliance, quality improvement, utilization management , denials management and management of ... jobs nationwide. **_JOB SUMMARY_** The Interim Leader of Case Management Services is a Registered Nurse who...that the following functions of the role are completed: Utilization Review for medical necessity of admission and concurrent… more
- HCA Healthcare (Nashville, TN)
- …want to join an organization that invests in you as a Director Case Management ? At TriStar Skyline Medical Center, you come first. HCA Healthcare has committed up ... difference. We are looking for a dedicated Director Case Management like you to be a part of our...to ensure continuity of care and optimal clinical resource utilization . The Director has oversight for all aspects of… more
- Adecco US, Inc. (Nashville, TN)
- **Case Management Director** **Position Title:** Director of Case Management **Location:** Nashville, TN **Position Type:** Full-Time | Day Shift (No Weekends) ... available on a case-by-case basis) **Position Overview** The Director of Case Management is responsible for the overall leadership, management , and coordination… more
- Select Medical (Nashville, TN)
- … within the plan of care. + Demonstrates compliance with facility-wide Utilization Management policies and procedures. + Coordinates UR compliance with ... current licensure in a clinical discipline either as a Nurse or a Respiratory Therapist OR Social Work SW/MSW...what is right. The Case Manager is responsible for utilization reviews and resource management , discharge planning,… more
- Select Medical (Nashville, TN)
- … within the plan of care. + Demonstrates compliance with facility-wide Utilization Management policies and procedures. + Coordinates UR compliance with ... current licensure in a clinical discipline either as a Nurse or a Respiratory Therapist OR Social Work SW/MSW...what is right. The Case Manager is responsible for utilization reviews and resource management , discharge planning,… more
- HCA Healthcare (Nashville, TN)
- …required (LPC, LMFT, LCSW, LADAC) + Previous experience in Needs Assessment and Utilization Management strongly preferred. + Familiarity with required DSM V-R ... nurses play a vital part. We know that every nurse 's path and purpose is unique. Do you want...reimbursed by contacting managed care organizations and completing initial utilization review. Documents in Midas as required. Involves mobile… more
- Sharecare (Nashville, TN)
- …/ new hire plan selection, claims issues, ID card issues, grievances/appeals, utilization management (UM) status, including but not limited to medical, ... + Claims adjustments + Grievances and appeals submissions + Utilization management intake or status + Complex...and second opinion. + Referring members to Clinical Advocates ( Nurse ) for conditions that require clinical care and case… more
- Trevecca Center for Rehabilitation and Healing (Nashville, TN)
- …the administrator in development of the annual budget. Appropriate and effective utilization of staff. Managing key operations and financial levers to achieve budget ... in the facility's Employee Handbook and as communicated by the facility's management . Contributing to a positive work team by sharing information, using problem… more
- HCA Healthcare (Nashville, TN)
- …department performance in accordance with established budget, including the utilization of staffing, supplies, equipment identifying cost reduction opportunities to ... nursing practice of the organization through clinical education and competency management + Consistently seeks improvement opportunities to enhance the effectiveness… more