- Staffing Now (Nashville, TN)
- …precertification, prior authorization, and post service requests. Refers cases requiring clinical review to a Nurse reviewer. Responsible for the identification ... openings! Responsible for coordinating cases for precertification and prior authorization review . Primary duties may includes, but are not limited: Managing incoming… more
- Staffing Now (Nashville, TN)
- SNI Companies has immediate jobs openings for a Utilization Management Representative! 100% on-siteMon - Fri / 8:30-5 EST$17 / hour Responsible for coordinating ... precertification, prior authorization, and post service requests.Refers cases requiring clinical review to a Nurse reviewer.Responsible for the identification… more
- Lincoln Financial Group (Nashville, TN)
- …Experience and/or proficiency with Disability Management (STD/LTD) knowledge, Workers Compensation, Utilization Review and/or nurse case management ... Role at a Glance** We are excited to bring on a highly motivated Nurse Disability Consultant to our clinical organization. This position will be responsible for… more
- Ascension Health (Nashville, TN)
- …additional specifics._ **Responsibilities** Provide health care services regarding admissions, case management , discharge planning and utilization review . + ... planning needs with healthcare team members. + May prepare statistical analysis and utilization review reports as necessary. + Oversee and coordinate compliance… more
- Elevance Health (Nashville, TN)
- …**How you will make an impact:** + Develops, maintains, and enhances the claims review process. + Assists management with developing unit goals, policies, and ... Nurse Audit Lead - Carelon Payment Integrity **Location:**...responsible for identifying, monitoring, and analyzing aberrant patterns of utilization and/or fraudulent activities by healthcare providers through prepayment… more
- Veterans Affairs, Veterans Health Administration (Nashville, TN)
- … nurse independently provides patient-centered and recovery-oriented care, milieu management , and maintains self-awareness while caring for patients living with ... by the VHA Education Loan Repayment Services program office after complete review of the EDRP application. Responsibilities The Inpatient Mental Health (MH)… more
- ChenMed (Nashville, TN)
- …explain nurse practitioner role. + Facilitates patient/family conferences to review treatment goals, optimize resource utilization , provide family education ... **Job Requirements** The Nurse Practitioner must demonstrate the ability to function...management programs, clinical meetings and other meetings. The Nurse Practitioner will adhere to strict departmental goals/objectives, standards… more
- Prime Therapeutics (Nashville, TN)
- …of post-degree clinical experience. + Experience in managed care, specialty drugs, care management and utilization review . + Meets Magellan Credentialing ... and drives every decision we make. **Job Posting Title** Infusion Referral Nurse - REMOTE **Job Description Summary** Under supervision, is responsible for performing… more
- The Cigna Group (Nashville, TN)
- …at home to improve quality of life, increase understanding and management of serious illness, facilitate coordination between providers, and decrease unnecessary ... includes health risk assessments, transitions of care, complex and chronic disease management , and palliative care support. We conduct in-home longitudinal care for… 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
- Sedgwick (Nashville, TN)
- …and consult review ; and two (2) years of experience in daily application of nurse auditing, utilization review and bill review . **Skills & ... Great Place to Work(R) Most Loved Workplace(R) Forbes Best-in-State Employer RN Bill Review **PRIMARY PURPOSE** **:** To review hospital and professional medical… more
- HCA Healthcare (Smyrna, TN)
- …patient throughput while supporting a balance of optimal care and appropriate resource utilization . . provides case management services for both inpatient and ... compassion and comfort in our modern facility. The Registered Nurse (RN) CM is responsible for promoting patient-centered care...path, we encourage you to apply for our Case Management RN PRN opening. We review all… 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 ... Sign-on bonus available for candidates who qualify! The Registered Nurse (RN) CM is responsible for promoting patient-centered care...path, we encourage you to apply for our Case Management RN opening. We review all applications.… 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 ... Centennial Medical Center! **Job Summary and Qualifications** The Registered Nurse (RN) CM is responsible for promoting patient-centered care...path, we encourage you to apply for our Case Management RN PRN opening. We review all… more
- Highmark Health (Nashville, TN)
- …Inc. **Job Description :** **JOB SUMMARY** This job implements the effective utilization management strategies including: review of appropriateness of ... and offers interventions and/or alternatives. **ESSENTIAL RESPONSIBILITIES:** + Implement care management review processes that are consistent with established… 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
- 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 as… 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
