- Humana (Nashville, TN)
- …community and help us put health first** Full-Time, Remote Telephonic opportunity The Utilization Management Nurse 2 utilizes clinical nursing skills to ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...+ Minimum of Associate Degree in nursing + Licensed Registered Nurse ( RN ) in a… more
- 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...skills to make an impact** **Required Qualifications** + **Licensed Registered Nurse ( RN )** in the… more
- 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...skills to make an impact** **Required Qualifications** + Licensed Registered Nurse ( RN ) in the… more
- Cognizant (Nashville, TN)
- …have to be considered** . Educational background - Registered Nurse ( RN ) . 2-3 years combined clinical and/or utilization management experience with ... Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact...care revenue cycle or clinic operations . Experience in utilization management to include Clinical Appeals and… more
- CenterWell (Nashville, TN)
- …clinical experience. + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Intelligence + ... put health first** Conviva Care Solutions is seeking a RN who will collaborate with other health care givers...Experience with Home Health preferred + Previous experience in utilization management within Insurance industry a plus… more
- Community Health Systems (Franklin, TN)
- …Knowledge of HIPAA regulations and patient confidentiality standards. **Licenses and Certifications** + RN - Registered Nurse - State Licensure and/or ... appropriateness, and efficiency of hospital services to ensure compliance with utilization management policies. This role conducts admission and continued… more
- YesCare Corp (Brentwood, TN)
- …+ Assist in completion of special projects on an as needed basis. **Key Qualifications:** + Registered Nurse ( RN ) active license + No less than 5 years' ... as indicated. + Communicate and guide staff and physicians regarding utilization management program development, implementation, and evaluation and… more
- Select Medical (Nashville, TN)
- … within the plan of care. + Demonstrates compliance with facility-wide Utilization Management policies and procedures. + Coordinates UR compliance with ... what is right. The Case Manager is responsible for utilization reviews and resource management , discharge planning,...**Current licensure in a clinical discipline either as a Nurse ( RN /LPN/ LVN)or a Respiratory Therapist… more
- Select Medical (Nashville, TN)
- … within the plan of care. + Demonstrates compliance with facility-wide Utilization Management policies and procedures. + Coordinates UR compliance with ... current licensure in a clinical discipline either as a Nurse ( RN /LPN/LVN) or a Respiratory Therapist (RT)...what is right. The Case Manager is responsible for utilization reviews and resource management , discharge planning,… more
- Humana (Nashville, TN)
- **Become a part of our caring community and help us put health first** The Utilization Management Behavioral Health Nurse 2 utilizes clinical nursing skills ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Behavioral Health Nurse 2 work… more
- Vanderbilt University Medical Center (Nashville, TN)
- …emphasizing negative elements. **Position Qualifications:** **Responsibilities:** **Certifications:** LIC- Registered Nurse - Licensure-Others **Work ... to impact pediatric patients and families from the beginning - Autonomy and Utilization of Critical Skills - Teamwork that displays comradery and family center care… more
- Highmark Health (Nashville, TN)
- …Nursing **EXPERIENCE** **Required** + 7 years in any combination of clinical, case/ utilization management and/or disease/condition management experience, or ... in addressing targeted populations **LICENSES or CERTIFICATIONS** **Required** + RN license in PA or WV or DE or...first 6 months of employment. **Preferred** + Certification in utilization management or a related field +… more
- Elevance Health (Nashville, TN)
- …in an ambulatory or hospital setting or minimum of 1 year of prior utilization management , medical management and/or quality management , and/or ... ** Nurse Reviewer I** **Virtual:** This role enables associates...required. **Preferred Skills, Capabilities, and Experiences:** + Familiarity with Utilization Management Guidelines, ICD-9 and CPT-4 coding,… more
- HCA Healthcare (Nashville, TN)
- …required (LPC, LMFT, LCSW, LADAC) + Previous experience in Needs Assessment and Utilization Management strongly preferred. + Familiarity with required DSM V-R ... nurses play a vital part. We know that every nurse 's path and purpose is unique. Do you want...that improve quality of care, service and operations. + RN 's Only - Performs medical screenings on all patients… more
- Highmark Health (Nashville, TN)
- …and education or if necessary involve Special Investigation Unit or the Utilization Management area. **ESSENTIAL RESPONSIBILITIES** + Implement the pre-payment ... data to assure appropriate level of payment and resource utilization . It is also used to identify issues which...experience in Managed Care **LICENSES or CERTIFICATIONS** **Required** + Registered Nurse **Preferred** + Certified Medical Coder… more
- Evolent (Nashville, TN)
- …responsible for support and assistance for all cardiology administrative and clinical utilization management and quality improvement functions under the auspices ... in a regulatory role (preferred). **LICENSE/CERTIFICATION:** Current, unrestricted state PA or RN /NP license in medicine or required specialty. Of a PA, obtaining a… more
- Wellpath (Franklin, TN)
- …from an accredited School of Nursing or Care Management Certification + RN preferred EXPERIENCE + Previous utilization review and/or case management ... you make a difference** The Regional Care Manager (RCM) is responsible for utilization review, care coordination, and daily care management across multiple sites… more
- Elevance Health (Spring Hill, TN)
- …unless an accommodation is granted as required by law._ The **LTSS Service Coordinator- RN ** is responsible for overall management of member's case within the ... **LTSS Service Coordinator - RN ** **Location:** The location for this position includes Knox, Anderson, Claiborne, Williamson, Davidson, Montgomery, Shelby, Tipton,… more
- HCA Healthcare (Nashville, TN)
- **Description** **8k Sign on bonus for qualified RN candidates!** **Introduction** Do you currently have an opportunity to make a real impact with your work? With ... to make a real impact. As a(an) Case Manager RN you can be a part of change. **Benefits**...location._** It is an exciting time to be a nurse at HCA Healthcare! Come unlock your career potential… more
- HCA Healthcare (Nashville, TN)
- …**Introduction** Do you have the PRN career opportunities as a(an) Case Manager RN PRN you want with your current employer? We have an exciting opportunity ... Do you want to work as a(an) Case Manager RN PRN where your passion for creating positive patient...stay, managing the length of stay, ensuring appropriate resource management and developing a safe appropriate discharge plan in… more