- Humana (Nashville, TN)
- …of the appropriate courses of action. The Utilization Management Nurse 2/ Home Health Utilization Management : + Review cases using clinical ... part of our caring community and help us put health first** The Utilization Management ...with no disciplinary action + Clinical experience in Medicare Home Health (in the last 12 months)… more
- Humana (Nashville, TN)
- **Become a part of our caring community and help us put health first** The Utilization Management Clinical Pharmacist 2 (VSP/PT) is a clinical pharmacist who ... and comprehensive medication reviews for prescriptions requiring pre-authorization. The Utilization Management Clinical Pharmacist 2 (VSP/PT) work assignments… more
- Elevance Health (Nashville, TN)
- …to work remotely from home . _A proud member of the Elevance Health family of companies, Carelon Medical Benefits Management , formerly AIM Specialty ... **Clinical Operations Medical Director** ** Utilization Management of Medical Oncology Benefits**...Health , is a benefit- management leader in Illinois. Our platform delivers significant cost-of-care… more
- Humana (Nashville, TN)
- **Become a part of our caring community and help us put health first** The Process Improvement Professional 2 analyzes, and measures the effectiveness of existing ... following areas: benchmarking, business process analysis and re-engineering, change management and measurement, and/or process-driven systems requirements. Understands department,… more
- HCA Healthcare (Nashville, TN)
- …Supervises, monitors, and ensures competencies and performance of assigned home health care team(s) Supervises ongoing case management of all patients ... Home we support our colleagues in their positions. Join our Team as a(an) Home Health RN Clinical Manager and access programs to assist with every stage of… more
- The Cigna Group (Nashville, TN)
- …Responsibilities:** + Responsible for the effective and sufficient support of all Utilization Management activities to include review of inpatient and outpatient ... regular trainings and other collaborative meetings as appropriate. + Works with management team to achieve operational objectives and financial goals. + Supports… more
- CenterWell (Nashville, TN)
- …largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is ... Coordinate quality improvement activities to address high risk, high-utilizers/high-cost patient management through the utilization of the 5M's framework as… more
- Humana (Nashville, TN)
- …put health first** This is a non-exempt position with responsibility for utilization management and clinical decision-making as outlined in the Autism Care ... Responsibilities** Tasks include, but are not limited to: **70%** : Performing utilization management activities for assigned areas. Ensures full compliance with… more
- Evolent Health (Nashville, TN)
- …for selecting health plans or regions, assuming overall accountability for utilization management while working in conjunction with the Senior Medical ... **Your Future Evolves Here** Evolent partners with health plans and providers to achieve better outcomes...Reviewer you will be a key member of the utilization management team. We can offer you… more
- HCA Healthcare (Nashville, TN)
- …to join an organization that invests in you as a Director of Clinical Case Management ? At HCA Healthcare, you come first. HCA Healthcare has committed up to $300 ... years. **Benefits** HCA Healthcare, offers a total rewards package that supports the health , life, career and retirement of our colleagues. The available plans and… more
- Evolent Health (Nashville, TN)
- …Be Doing:** As a Physician Clinical Reviewer you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... the Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. +… more
- Humana (Nashville, TN)
- …teams focusing on quality management , utilization management , case management , discharge planning and/or home health or post acute services such ... health insurance, other healthcare providers, clinical group practice management . + Utilization management experience in a medical management … more
- HCA Healthcare (Nashville, TN)
- …financial, and client satisfaction goals within a deadline + Knowledge of case management and/or utilization review preferred + Ability to manage multiple ... an organization that invests in you as a Case Management Manager Reporting Analytics? At HCA Healthcare, you come...Healthcare, offers a total rewards package that supports the health , life, career and retirement of our colleagues. The… more
- HCA Healthcare (Nashville, TN)
- …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 ... team. **Benefits** HCA Healthcare, offers a total rewards package that supports the health , life, career and retirement of our colleagues. The available plans and… more
- HCA Healthcare (Nashville, TN)
- … and supply chain operations. ii) Value Analysis iii) Clinical Resource Management Program iv) Product standardization and utilization + Interacts and ... invests in you as a Senior Director Clinical Resource Management ? At HealthTrust, you come first. HCA Healthcare has...HealthTrust, offers a total rewards package that supports the health , life, career and retirement of our colleagues. The… more
- Somatus (Nashville, TN)
- …Practitioner will ensure the delivery of high-quality patient care, efficient medical management , and effective utilization of healthcare resources, delivered by ... more days out of the hospital and healthier at home . It takes a village of passionate and tenacious...oversight, and strategic direction to enable success improving the health engagement and management of a population.… more
- Sharecare, Inc. (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...Assistant + Medical Secretary/Clinic Manager + Radiology Technician + Home Health Aide + Occupational Therapist Aide… more
- Humana (Nashville, TN)
- …teams focusing on quality management , utilization management , case management , discharge planning and/or home health or post-acute services (such ... health insurance, other healthcare providers, clinical group practice management . + Utilization management experience...participate on project teams or organizational committees. **Work at Home Guidance** To ensure Home or Hybrid… 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 ... package that supports the health , life, career and retirement of our colleagues. The...protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care… more
- Elevance Health (Nashville, TN)
- …role required by a State agency. **Preferred Skills, Capabilities, and Experiences:** + Utilization Management experience is a plus. + Ability to meet necessary ... **Medical Director** At **Federal Health Products and Services - FHPS** , a...clinical reviews. + The Medical Director typically has program management responsibilities including clinical policy development, program development/implementation, and… more