- Humana (Nashville, TN)
- …independent determination of the appropriate courses of action. The Post-Acute Utilization Management Nurse 2: + Review Post-Acute Preauth cases using ... part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination,… 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 ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- Elevance Health (Nashville, TN)
- **Clinical Operations Medical Director** ** Utilization Management of Medical Oncology Benefits** **Carelon Benefits Management ** **$20,000 Sign On Bonus** ... members and providers. **Job Summary:** + Perform physician-level case review , following initial nurse review ,...maintain knowledge of relevant policies and regulations pertaining to utilization review of oncology care. + Participate… 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
- Humana (Nashville, TN)
- … management personnel and oversee all utilization management functions, including inpatient admissions, concurrent review , prior authorization, and ... put health first** Humana Healthy Horizons in Virginia is seeking a Manager, Utilization Management (Behavioral Health) who will utilize their clinical skills to… 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** **Supports the Carelon Payment Integrity...responsible for identifying, monitoring, and analyzing aberrant patterns of utilization and/or fraudulent activities by health care providers through… more
- Elevance Health (Nashville, TN)
- ** Nurse Reviewer I** **Location:** Within 50 miles of...hospital setting or minimum of 1 year of prior utilization management , medical management and/or ... state(s) required. **Preferred Skills, Capabilities, and Experiences:** + Familiarity with Utilization Management Guidelines, ICD-9 and CPT-4 coding, and managed… more
- The Cigna Group (Nashville, TN)
- …care or community setting + Minimum of two years of experience in Case Management or Utilization Review + Experience with physician's office practices ... and ensure end of life preferences are identified + Review recent admission trends and history with PCP and...MSSP regulations + HIPAA regulations + Knowledge of care management - utilization management , discharge planning, population… more
- Aveanna (Franklin, TN)
- …the plan of care and patient needs. + Participates in quality improvement, utilization review , and infection control activities as requested. + Attends ... Hospice Registered Nurse RN Full Time 10K Sign On Bonus...** Position Overview TheHospice Registered Nurseis responsible for pain management , symptom control in the delivery of care to… 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
- 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
- The Cigna Group (Nashville, TN)
- …skills + Typing and computer knowledge- able to type 35WPM + Knowledge of utilization review requirements and procedures + Knowledge of current health care ... to Five (3-5) years recent experience in an acute-care environment, case- management or utilization management position (experience can be a combination of… more
- Fresenius Medical Center (Antioch, TN)
- …auditing activities. + Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. + Manages clinic ... financials including efficient utilization of supplies or equipment and regular profits and...of supplies or equipment and regular profits and loss review . + Responsible for all required network reporting and… more
- Marriott (Nashville, TN)
- …with Claims department regarding case management . + Collaborate with UNM on utilization review issues. + Refer catastrophic cases in coordination with claims ... claims most likely to benefit from case management to meet jurisdictional needs. ** Utilization Review ** + Provide initial clinical review in order to… more
- HCA Healthcare (Nashville, TN)
- …this opportunity compelling, we encourage you to apply for our Manager Case Management opening. We promptly review all applications. Highly qualified candidates ... 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… 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 ... location._** It is an exciting time to be a nurse at HCA Healthcare! Come unlock your career potential...patients as a VP of Clinical Resource and Account Management . We want your knowledge and expertise! **Job Summary… 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 ... continue to learn! **Job Summary and Qualifications** The Registered Nurse (RN) CM is responsible for promoting patient-centered care...you, we encourage you to apply for our Case Management RN opening. Our team will promptly review… more
- Vanderbilt University Medical Center (Nashville, TN)
- …for the PCC. * Lead activities related to performance, improvement, and risk management programs in order to establish and meet clinical quality goals, effective ... cost management , patient satisfaction, and business goals. * Participates in...or VUMC goals. * Promote and monitor the effective utilization of the assigned space in support of the… more
- Green Hills Center for Rehabilitation and Healing (Nashville, TN)
- …meaningful contributions to the rehab team conferences, patient care conferences, utilization review meetings, family conferences, and caregiver training ... outlined in the facility's Employee Handbook and as communicated by the facility's management . + Contributing to a positive work team by sharing information, using… more