- Humana (Nashville, TN)
- …community and help us put health first** Full-Time, Remote Telephonic opportunity The Utilization Management Nurse 2 utilizes clinical nursing skills to ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...appropriate courses of action. As a Utilization Management RN working on the OneHome/ Home Solutions… 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
- 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
- Fresenius Medical Center (New Market, TN)
- …and acting on adverse events and action thresholds. + Oversees facility's Home Therapies Program if applicable. + Accountable for compliance with all applicable ... and acts as the liaison for patient care as per the disease management agreement, including initial and ongoing validation of member eligibility. Facilitate timely… more
- Fresenius Medical Center (Lebanon, TN)
- …Quality, and Technical Services departments. + Collaborates with or functions as the Home Therapies Program Manager to oversee the facility's Home Therapies ... Classification of Disease (ICD) coding. + Manages clinic financials including efficient utilization of supplies or equipment and regular profits and loss review. +… 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 ... protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage,… 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 ... protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care...nurses play a vital part. We know that every nurse 's path and purpose is unique. Do you want… more
- Covenant Health Inc. (Lenoir City, TN)
- Overview Registered Nurse Care Manager, Quality Management PRN/OCC,Hours and Shifts Vary Fort Loudoun Medical Center Overview: Fort Loudoun Medical Center is ... reports directly to the Manager/Coordinator of Quality and Care Management at the facility level. Recruiter: Sandra Simmons ||...and Coordination of Care: + Collaborates directly with the Nurse Manager to ensure the staff adheres to sound… more
- Covenant Health Inc. (Knoxville, TN)
- …administrative and regulatory purposes. + Develops and directs efficient materials management process. Ensures cost-efficient ordering and utilization of ... Overview Nurse Manager of Oncology Clinic & Infusion Center...cancer and radiation centers closer to where you call home . All Thompson Oncology Group practices are committed to… 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
- HCA Healthcare (Nashville, TN)
- …protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, ... and adoption assistance. + Referral services for child, elder and pet care, home and auto repair, event planning and more + Consumer discounts through Abenity… more
- Covenant Health Inc. (Harriman, TN)
- …and reports directly to the Manager/Coordinator of Quality and Care Management at the facility level Recruiter:Sandra Simmons ||###@covhlth.com Responsibilities + ... patient is meeting daily objectives. + Modifies the case management plan to meet the changing needs of the...appropriate disciplines are available + Collaborates directly with the Nurse Manager to ensure the staff adheres to sound… more
- Covenant Health Inc. (Harriman, TN)
- …and reports directly to the Manager/Coordinator of Quality and Care Management at the facility level. Recruiter:Sandra Simmons || ###@covhlth.com Responsibilities + ... patient is meeting daily objectives. + Modifies the case management plan to meet the changing needs of the...appropriate disciplines are available + Collaborates directly with the Nurse Manager to ensure the staff adheres to sound… more
- Covenant Health Inc. (Knoxville, TN)
- Overview Registered Nurse Care Manager, Social Services PRN/OCC, Variable Hours and Shifts Fort Sanders Regional Overview: Fort Sanders Regional Medical Centeris a ... unit and reports directly to the Manager/Coordinator of Quality and Care Management at the facility level Recruiter: Lacey Spoon || ###@covhlth.com Responsibilities… more
- Gentiva (Knoxville, TN)
- …licensed Registered Nurse (RN) with strong leadership experience in hospice care, home health, or clinical operations management . If you're a natural leader ... budgeting while driving branch revenue growth through census development, referral management , and efficient resource utilization + Maintain strong relationships… more
- Community Health Systems (Powell, TN)
- …health, or nursing home setting required + 2-4 years of care management experience preferred **Knowledge, Skills and Abilities** + Strong understanding of case ... coordinating and overseeing discharge planning, transitions of care, and case management activities to ensure optimal patient outcomes. This role involves… more
- HCA Healthcare (Nashville, TN)
- …protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, ... and adoption assistance. + Referral services for child, elder and pet care, home and auto repair, event planning and more + Consumer discounts through Abenity… more
- Covenant Health Inc. (Morristown, TN)
- …for all encounters admitted through the Emergency Department for the Advanced Care at Home program and Utilization Management . + Rotates on-call and holiday ... Excellence, women can have their annual mammograms, biopsies, and can meet with a nurse navigator if needed. The Women's Center offers six newly remodeled labor and… more