- 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)
- … (UM) Nurse Consultant. As a Utilization Management Nurse Consultant, you will utilize clinical skills to coordinate, document and communicate all ... and state regulated turn-around times. This includes reviewing written clinical records. **Key Responsibilities of the UM Nurse...practice experience as an RN required. + 2+ Years Utilization Management experience. + Must be willing… 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
- CVS Health (Nashville, TN)
- … skills to coordinate, document and communicate all aspects of the utilization /benefit management program. Applies critical thinking and is knowledgeable in ... and external constituents in the coordination and administration of the utilization /benefit management function. **Required Qualifications** + 3+ years post… 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
- Elevance Health (Nashville, TN)
- RN - Utilization / Medical Management Nurse... experience and requires a minimum of 2 years clinical , utilization review, or managed care experience; ... - 6pm PST. Rotating Weekends and holidays. The **Medical Management Nurse ** is responsible for review of...Med/Surg, Critical Care, ER, Telemetry, etc. strongly preferred. + Utilization management /review within managed care or hospital… 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
- Humana (Nashville, TN)
- **Become a part of our caring community and help us put health first** The Appeals Nurse 2 resolves clinical complaints and appeals. The Appeals Nurse 2 work ... Office products including Word, Excel and Outlook **Preferred Qualifications** + Utilization Review/Quality Management experience + Experience working with MCG… more
- Gallatin Center for Rehabilitation and Healing (Gallatin, TN)
- Schedule . 5 days a week 37.5 - 40 hours per week Respiratory Nurse (RN) We are searching for a highly motivated, flexible, organized, skilled respiratory therapist ... patient needs and uses current treatment knowledge in accordance with facilities clinical procedures. This includes but is not limited to: . Performing accurate,… 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
