- BlueCross BlueShield of Tennessee (Nashville, TN)
- …we'd love to have you on our team\. **Job Responsibilities** + Supporting utilization management functions for more complex and non\-routine cases as needed\. ... looking for individuals with strong critical thinking skills, excellent time management , and the ability to prioritize task efficiently\. If you're self\-motivated… more
- CVS Health (Nashville, TN)
- …And we do it all with heart, each and every day. **Position Summary:** The ** Utilization Management Clinical Nurse Consultant - Prior Authorization** ... internal and external constituents in the coordination and administration of the utilization /benefit management function. + Gathers clinical information and… more
- Humana (Nashville, TN)
- …help us put health first** Full-Time, Remote Telephonic opportunity The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- Cognizant (Nashville, TN)
- …. Educational background - Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management experience with managed health care plan ... Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced...care revenue cycle or clinic operations . Experience in utilization management to include Clinical … more
- Humana (Nashville, TN)
- …of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, ... determination of the appropriate courses of action. The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and independent… more
- CVS Health (Nashville, TN)
- …internal and external constituents in the coordination and administration of the utilization /benefit management function. + Gathers clinical information and ... skills to coordinate, document, and communicate all aspects of the utilization /benefit management program. + Applies critical thinking and knowledge in… more
- Community Health Systems (Franklin, TN)
- …Documents all utilization review activities in the hospital's case management software, including clinical reviews, escalations, avoidable days, payer ... + 2-4 years of clinical experience in utilization review, case management , or acute care...confidentiality standards. **Licenses and Certifications** + RN - Registered Nurse - State Licensure and/or Compact State Licensure required… more
- Evolent (Nashville, TN)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Nurse Reviewer is responsible for performing precertification and prior approvals. Tasks are ... independent nursing judgement and decision-making, physician-developed medical policies, and clinical decision-making criteria sets. Acts as a member advocate by… more
- Sharecare (Nashville, TN)
- …helps to drive cost effective and appropriate resource utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during ... for everyone. To learn more, visit www.sharecare.com . **Job Summary:** The Disease Management Nurse has the responsibility for supporting the goals and… more
- CVS Health (Nashville, TN)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... self-insured clients. + Application and/or interpretation of applicable criteria and clinical guidelines, standardized care management plans, polices, procedures… more
- Veterans Affairs, Veterans Health Administration (Nashville, TN)
- …The Nashville VA Medical Center is seeking a highly motivated and experienced Registered Nurse to serve as a Research Nurse within the Research and Development ... Service. The incumbent will play a critical role in supporting clinical research activities, ensuring regulatory compliance, and promoting Veteran-centered care… more
- Highmark Health (Nashville, TN)
- …Degree in Nursing **EXPERIENCE** **Required** + 7 years in any combination of clinical , case/ utilization management and/or disease/condition management ... panel of members that range in health status/severity and clinical needs; and assesses health management needs...first 6 months of employment. **Preferred** + Certification in utilization management or a related field +… more
- Elevance Health (Nashville, TN)
- …criteria._** The **Telephonic Nurse Case Manager II** is responsible for care management within the scope of licensure for members with complex and chronic care ... **Telephonic Nurse Case Manager II** **Location:** This role enables...claims or service issues. + Assists with development of utilization /care management policies and procedures. **Minimum requirements:**… more
- Evolent (Nashville, TN)
- …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and ... accomplishments. **What You Will Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to company… more
- Elevance Health (Nashville, TN)
- …The **Telephonic Nurse Case Manager Senior** is responsible for care management within the scope of licensure for members with complex and chronic care ... **Telephonic Nurse Case Manager Senior** **Location:** This role enables...claims or service issues. + Assists with development of utilization /care management policies and procedures, chairs and… more
- Vanderbilt University Medical Center (Nashville, TN)
- …to impact pediatric patients and families from the beginning - Autonomy and Utilization of Critical Skills - Teamwork that displays comradery and family center care ... * Analyzes comprehensive information pertinent to the patient's care and management to determine nursing diagnosis. * Continually utilizes the nursing process… more
- HCA Healthcare (Nashville, TN)
- …improved nursing and allied health practices of the organization through clinical education and competency management . + Consistently seeks improvement ... platform. This includes the educational aspects of orientation and onboarding of clinical employees and development of education that addresses EHR practice gaps for… more
- HCA Healthcare (Nashville, TN)
- …They Manage department operations to include staff schedule, staff productivity, resource utilization and expense management to ensure quality patient care and ... or limits? Our TriStar Centennial Medical Center team is looking for a Clinical Operations Manager. HCA Healthcare is an advanced healthcare network that has… more
- HCA Healthcare (Nashville, TN)
- …hospital departments and external agencies to ensure continuity of care and optimal clinical resource utilization . The Director has oversight for all aspects of ... in Nursing, Health Administration, or Business Administration, preferred + Either Registered Nurse (RN) licensure , Licensed Clinical Social Worker (LCSW) or… more
- Highmark Health (Nashville, TN)
- …timeframes and notification requirements are met. + Communicate effectively with Utilization Management Staff, providers, other internal and external customers ... requirements. Documents, processes and routes requests for services to the nurse reviewer and other departments based on documentation procedures, including review… more
