- Humana (Nashville, TN)
- …of action. The Utilization Management Nurse 2/Home Health Utilization Management : + Review cases using clinical knowledge, communication skills, ... 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
- Elevance Health (Nashville, TN)
- **Clinical Operations Medical Director** ** Utilization Management of Medical Oncology Benefits** **Carelon Benefits Management ** **$20,000 Sign On Bonus** ... members and providers. **Job Summary:** + Perform physician-level case review , following initial nurse review ,...maintain knowledge of relevant policies and regulations pertaining to utilization review of oncology care. + Participate… more
- The Cigna Group (Nashville, TN)
- …care or community setting + Minimum of two years of experience in Case Management or Utilization Review + Experience with physician's office practices ... and ensure end of life preferences are identified + Review recent admission trends and history with PCP and...MSSP regulations + HIPAA regulations + Knowledge of care management - utilization management , discharge planning, population… more
- Aveanna (Franklin, TN)
- …the plan of care and patient needs. + Participates in quality improvement, utilization review , and infection control activities as requested. + Attends ... Hospice Registered Nurse RN Full Time 10K Sign On Bonus...** Position Overview TheHospice Registered Nurseis responsible for pain management , symptom control in the delivery of care to… more
- Vanderbilt University Medical Center (Nashville, TN)
- …if additional records requests or actions might be indicated * Experience/proficiency in the review and the utilization of EPIC and/or eStar including the Media ... the VPEC OHO Clinic * Comfortable with the clinical review of testing results and visit plans to determine...tab, Care Everywhere, StarPanel, dot phrases, message basket management , and sending communications * Experience/proficiency in the use… 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 ... and ensures that appropriate follow-up action is taken + Facilitates the Care Management Process engaging the resident, IDT and family in timely identification and… more
- The Cigna Group (Nashville, TN)
- …skills + Typing and computer knowledge- able to type 35WPM + Knowledge of utilization review requirements and procedures + Knowledge of current health care ... to Five (3-5) years recent experience in an acute-care environment, case- management or utilization management position (experience can be a combination of… more
- HCA Healthcare (Nashville, TN)
- …this opportunity compelling, we encourage you to apply for our Manager Case Management opening. We promptly review all applications. Highly qualified candidates ... where diversity and inclusion thrive? Submit your application for our Manager Case Management opening with HCA Healthcare today and find out what it truly means… more
- The Cigna Group (Nashville, TN)
- …and Responsibilities:** + Responsible for the effective and sufficient support of all Utilization Management activities to include review of inpatient and ... Medical Directors when services do not meet criteria or require additional review . + Participation in staff meetings, regular trainings and other collaborative… more
- The Cigna Group (Nashville, TN)
- …Requirements include, but not limited to:** + Must have experience in Medicare Appeals, Utilization Case Management or Compliance in Medicare Part C + Ability to ... Medicare appeals and related issues, implications and decisions. The Case Management Analyst reports to the Supervisor/Manager of Appeals and will coordinate… more
- HCA Healthcare (Nashville, TN)
- …opportunity to make a real impact. As a VP of Clinical Resource and Account Management you can be a part of change. **Benefits** HealthTrust, offers a total rewards ... location._** It is an exciting time to be a nurse at HCA Healthcare! Come unlock your career potential...patients as a VP of Clinical Resource and Account Management . We want your knowledge and expertise! **Job Summary… more
- HCA Healthcare (Nashville, TN)
- …patient throughput while supporting a balance of optimal care and appropriate resource utilization . Provides case management services for both inpatient and ... continue to learn! **Job Summary and Qualifications** The Registered Nurse (RN) CM is responsible for promoting patient-centered care...you, we encourage you to apply for our Case Management RN opening. Our team will promptly review… more
- HCA Healthcare (Nashville, TN)
- …should confirm with NCBON. **Preferred Certification:** Nationally accepted certification in Case Management , Utilization Review , Coding, or other denial ... in denial management . + Requires professional level of knowledge of utilization review , care management , InterQual and/or medical necessity methods,… more
- Vanderbilt University Medical Center (Nashville, TN)
- …- Neuroscience. The Associate Nursing Officer - Neuroscience shall provide general management for the operations of a Patient Care Center by providing administrative ... * Lead activities related to performance, improvement, and risk management programs in order to establish and meet clinical...or VUMC goals. * Promote and monitor the effective utilization of the assigned space in support of the… more
- Vanderbilt University Medical Center (Nashville, TN)
- …for the PCC. * Lead activities related to performance, improvement, and risk management programs in order to establish and meet clinical quality goals, effective ... cost management , patient satisfaction, and business goals. * Participates in...or VUMC goals. * Promote and monitor the effective utilization of the assigned space in support of the… more
- Vanderbilt University Medical Center (Nashville, TN)
- …research, and patient care missions of the University's Medical Center. * Review , establish, and revise policies, procedures, and standards related to all aspects ... Create programs to meet the future market requirements. * Monitor and review departmental performance of productivity targets. * Implement changes for improvement… more
- HCA Healthcare (Nashville, TN)
- …developing long and short term plans; refer cases to the discharge planner and/or utilization nurse when needs are identified. + Adhere to plans, policies, and ... for avoidable days to identify opportunities for throughput; communicating with utilization review and/or discharge planners impending denials or non-certified… more
- HCA Healthcare (Nashville, TN)
- …and performance of assigned home health care team(s) Supervises ongoing case management of all patients ensuring an accurate evaluation and treatment plan, ... clinicians regarding deficiencies or OASIS corrections (with feedback from Quality Review Specialist) to ensure the medical records reflect compliance with medical… more
- Green Hills Center for Rehabilitation and Healing (Nashville, TN)
- …meaningful contributions to the rehab team conferences, patient care conferences, utilization review meetings, family conferences, and caregiver training ... outlined in the facility's Employee Handbook and as communicated by the facility's management . + Contributing to a positive work team by sharing information, using… more
- HCA Healthcare (Nashville, TN)
- …onsite assessments of focused topics within HCA Healthcare hospitals/ASCs including credentialing, utilization management , peer review , medical staff and ... guidance to division vice president, quality or director, quality and risk management . **Up to 75% TRAVEL REQUIRED** **Major Responsibilities** * Individual serves… more