- 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 ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...action. Humana is seeking a Part C Grievance & Appeals (G&A) Nurse who will assist in… more
- Community Health Systems (Franklin, TN)
- …appropriateness, and efficiency of hospital services to ensure compliance with utilization management policies. This role conducts admission and continued ... stay reviews, supports denials and appeals activities, and collaborates with healthcare providers to facilitate...extended stays, identifying opportunities for process improvements to enhance utilization management . + Serves as a key… more
- Sharecare (Nashville, TN)
- …open enrollment / new hire plan selection, claims issues, ID card issues, grievances/ appeals , utilization management (UM) status, including but not limited ... 3rd parties for: + Claims adjustments + Grievances and appeals submissions + Utilization management ...and second opinion. + Referring members to Clinical Advocates ( Nurse ) for conditions that require clinical care and case… more