- 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 ... Relations Manager to facilitate coordination of services related to utilization review . Collaborates with the multidisciplinary team, lending professional… more
- Community Health Systems (Franklin, TN)
- …appropriate additional documentation from the physician(s). + Escalates cases to the Utilization Review Manager and/or Physician Advisor if physicians ... of medical services and procedures in the hospital setting. Utilization review is the assessment for medical...event a facility does not have an ED Case Manager present, the UR Clinical Specialist will collaborate with… 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
- Prime Therapeutics (Nashville, TN)
- …hoc reports are provided accurately and on time. + Supports the State Drug Utilization Review Boards and Pharmacy and Therapeutics (P&T) Committee. Potential pay ... every decision we make. **Job Posting Title** Pharmacist Account Manager - New York Remote **Job Description**...may vary by 8% depending on applicant location. To review our Benefits, Incentives and Additional Compensation, visit our… more
- Community Health Systems (Franklin, TN)
- …appropriateness, and efficiency of medical services and procedures in the hospital setting. Utilization review is the assessment for medical necessity, both for ... to the hospital as well as continued stay. The Utilization Review Clinical Specialist supports and coordinates...and extended hospitals stays. The specialist will assist the manager in implementing process improvement plans and projects to… more
- Prime Therapeutics (Nashville, TN)
- …licensed functions (Pharmacy Benefit Management (PBM), Third Party Administrator, Utilization Review Organization, Business, State registrations, etc); compile ... **Job Posting Title** Senior Compliance Analyst (Interpretation and Advising) - Remote **Job Description** The Senior Compliance Analyst assists in the… more
- Prime Therapeutics (Nashville, TN)
- …and drives every decision we make. **Job Posting Title** Underwriter - Remote **Job Description** The Underwriter is responsible for assisting in the development ... response to moderate to complex RFP's + Evaluates the utilization and financial experience of customers and prospects +...ability to adjust focus **Reporting Structure** + Reports to Manager or Director in the Finance Department Potential pay… more
- Elevance Health (Nashville, TN)
- …regarding case and determines appropriate area to refer or assign case ( utilization management, case management, QI, Med Review ). + Provides information ... reports and documents all actions. + Responsibilities exclude conducting any utilization management review activities which require interpretation of clinical… more
- United Therapeutics (Nashville, TN)
- …with superior financial performance and our communities with earth-sensitive energy utilization . Our company was founded by an entrepreneur whose daughter was ... of benefit/risk of UTC products. This position can be remote in the continental US, or in our RTP,...Act as the main point of contact and functional manager for day-to-day questions or issue escalation regarding PM… more