- Community Health Systems (Franklin, TN)
- **Job Summary** The Manager of Utilization Review oversees a team of utilization review nurses and coordinators, ensuring compliance with clinical ... regulatory standards, and enhancing the overall utilization review process to optimize patient care...+ 3-5 years work experience in healthcare as a nurse required + 1-3 years work experience in Care… more
- Baptist Memorial (Memphis, TN)
- Summary The Utilization Review Nurse is responsible for evaluating the medical necessity and appropriateness of healthcare services and treatment as ... prescribed by utilization review standards. The UR ...+ Employee referral program Job Summary: Position: 19737 - RN - Utilization Review Facility: BMHCC Corporate… more
- Ascension Health (Nashville, TN)
- …Provide health care services regarding admissions, case management, discharge planning and utilization review . + Review admissions and service requests ... planning needs with healthcare team members. + May prepare statistical analysis and utilization review reports as necessary. + Oversee and coordinate compliance… more
- Ascension Health (Nashville, TN)
- …initiatives. + Develop systems and processes for prospective, concurrent and retrospective utilization review for allself-funded and fully insured clients to ... **Details** + **Department:** Utilization Management + **Schedule:** Monday - Friday. 40...all clients. **Requirements** Licensure / Certification / Registration: + Registered Nurse credentialed from the Tennessee Board… more
- Humana (Nashville, TN)
- …Provider calls **Use your skills to make an impact** **Required Qualifications** + Licensed Registered Nurse ( RN ) compact license with no disciplinary action ... independent determination of the appropriate courses of action. The Post-Acute Utilization Management Nurse 2: + Review Post-Acute Preauth cases using… more
- Community Health Systems (Franklin, TN)
- …+ Demonstrated proficiency in computer and web-based applications. **Licenses and Certifications** + RN - Registered Nurse - State Licensure and/or Compact ... appropriateness, and efficiency of medical services and procedures in the hospital setting. Utilization review is the assessment for medical necessity, both for… more
- Lebanon Center for Rehabilitation and Healing (Lebanon, 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
- CenterWell (Murfreesboro, TN)
- …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and ... requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking...School of Nursing. + Current state license as a Registered Nurse . + Proof of current CPR.… more
- Vanderbilt University Medical Center (Nashville, TN)
- …emphasizing negative elements. **Position Qualifications:** **Responsibilities:** **Certifications:** LIC- Registered Nurse - Licensure-Others **Work ... requests or actions might be indicated * Experience/proficiency in the review and the utilization of EPIC and/or eStar including the Media tab, Care Everywhere,… more
- Baptist Memorial (Memphis, TN)
- …and/or life situation. Performs other duties as assigned. Responsibilities + Utilization Review + Discharge planning + Readmission Reduction Participation ... of patients throughout the continuum of care for appropriate utilization of resources, service delivery and compliance with federal...Hospital Department: WH Case Management Admin BMH Women's Category: Nurse RN Type: Clinical Work Type: Full… more
- The Cigna Group (Nashville, TN)
- The RN Coordinator serves as the key contact point for...as needed 3) 3+ years of experience as a Registered Nurse 4) Proficient level of experience with ... and make specific recommendations based on their goals 4. Review paperwork for patients to ensure it meets all...of the team to manage heath care cost and utilization **Provider Support** 1. Completes telephonic nursing assessments including… more
- HCA Healthcare (Nashville, TN)
- …step in your career path, we encourage you to apply for our Case Management RN opening. We review all applications. Qualified candidates will be contacted by a ... **Description** Sign-On Bonus available for qualified RN candidates! Do you have the career opportunities...supporting a balance of optimal care and appropriate resource utilization . What you will do in this role: +… more
- Nashville 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 ... RN MDS Director Nashville Center for Rehabilitation and...by their supervisor and Administrator MDS Director Qualifications: + Registered Nurse with current, active license in… more
- Baptist Memorial (Memphis, TN)
- …Masters in Nursing or related field Minimum: BSN Experience Preferred: Exp with utilization review processes Minimum: Two years of nursing experience in acute ... RN Facility: Baptist Cancer Center Foundation Department: TC BCC Memphis Category: Nurse RN Type: Clinical Nurse Work Type: Full Time Work Schedule: Days… more
- STG International (Savannah, TN)
- …in the management/coordination of the clinic's day-to-day activity, in conjunction with the Registered Nurse ( RN )/CBOC Manager and VA Program's philosophy. + ... safety. + Participate in quality improvement, care management, risk management, peer review , utilization review , clinical outcomes, and health enhancement… more
- Covenant Health Inc. (Knoxville, TN)
- …five (3-5) years of experience in a clinical setting, case management, or utilization review experience preferred. Must be computer literate with basic knowledge ... services needed. The Care Navigator works under the guidance of the RN Care Coordinator and Quality Leadership to provide collaborative care management… more
- Houston Methodist (Nashville, TN)
- …- One year of clinical experience preferred **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure and/or Compact ... an acute care hospital setting is required; coding and utilization review experience preferred + For Medical...State Licensure within 60 days **OR** + RN -Temp - Registered Nurse -… more
- Highmark Health (Nashville, TN)
- …Sunday required in addition to 3 weekdays** This job implements effective utilization management strategies including: review of appropriateness of health care ... services, application of criteria to ensure appropriate resource utilization , identification of opportunities for referral to a Health Coach/case management, and… more
- Baptist Memorial (Memphis, TN)
- Summary May have administrative duties for risk management, utilization review , reimbursement, and oversight of all clinical patient care facilities with in ... for improved clinical patient outcomes. Requirements, Preferences and Experience Education: RN , BSN required Experience: Minimum 10 years of nursing experience with… more
- Humana (Nashville, TN)
- …status, etc. **Use your skills to make an impact** **Required Qualifications** + Licensed Registered Nurse ( RN ) compact licensure with no disciplinary action ... a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination,… more