- HCA Healthcare (Nashville, TN)
- …**Introduction** Do you want to join an organization that invests in you as a Case Management Managed Care Consultant? At HCA Healthcare, you ... like you to be a part of our team. **Job Summary and Qualifications** The Case Management Managed Care Consultant will serve as a Subject Matter Advisor… more
- Covenant Health Inc. (Knoxville, TN)
- Overview Manager Case Management Services, Continuum of Care Full Time, 80 Hours Per Pay Period, Day Shift Parkwest Overview: Headquartered in Knoxville, ... a recognized state of the art Case Management System that links cost of care ...are in place to minimize denials of claims by managed care organizations and insurance companies. Directs… more
- Elevance Health (Nashville, TN)
- **Manager II Case Management ** **Sign on Bonus: $5000** **Location** : This role requires associates to be in-office 3 days per week, fostering collaboration and ... Friday 8 - 5 pm EST.** The **Manager II Case Management ** is responsible for managing a...health or human services related field is preferred. + Managed Care experience is preferred. Please be… more
- Humana (Nashville, TN)
- … Management Team, providing a comprehensive, holistic approach for case management throughout the continuum of care . The case manager will offer ... the Case Manager will collaborate with other care management programs until the beneficiary's needs...delivery system. + Knowledge of MCG or Interqual. + Managed care experience. **Additional Information** **Work Days/Hours**… more
- Cardinal Health (Nashville, TN)
- …long and short-range changes in the reimbursement environment including Medicare, Medicaid, Managed Care , and Commercial medical and pharmacy plans while ... Patient Support helps specialty pharmaceutical manufacturers remove barriers to care so that patients can access, afford and remain...junior case managers on best practices in case management , patient interaction, and navigating internal… more
- Cardinal Health (Nashville, TN)
- …Remain knowledgeable about changes in the reimbursement environment (Medicare, Medicaid, Managed Care , Commercial plans). **Program Expertise & Continuous ... . Build and maintain professional relationships with all stakeholders, including case management , patient support services, medical, sales, market access,… more
- Health Care Service Corporation (Nashville, TN)
- …cases. + Certification in Case Management , Training, Project Management or nationally recognized health care certification. + Government Programs ... care coordination to members via telephonic and/or field-based care management to inform and educate them...days of hire. + Plus 3 years' wellness or managed care experience presenting clinical issues with… more
- Humana (Nashville, TN)
- …and use of business metrics. + Experience working with Case managers or Care managers on complex case management , including familiarity with social ... of decisions to internal associates, and possible participation in care management . May occasionally participate in discussions...in teams focusing on quality management , utilization management , case management , discharge planning… more
- Highmark Health (Nashville, TN)
- …Description :** **JOB SUMMARY** This job implements effective complimentary utilization and case management strategies for an assigned member panel. Provides ... member. The incumbent conducts outreach to members enrolled in case management including but is not limited...in a clinical setting **Preferred** + 5 years in UM/CM/QA/ Managed Care + 1 year in advanced… more
- Catholic Health Initiatives (Hixson, TN)
- …+ Minimum two (2) years of acute hospital clinical experience or a Masters degree in Case Management or Nursing field in lieu of 1 year experience. Preferred + ... Able to apply clinical guidelines to ensure progression of care . + Knowledge of managed care...stakeholders + Professional communication skills. + Understand how utilization management and case management programs… more
- Highmark Health (Nashville, TN)
- …in Medical Management in a Health Insurance Plan; strong knowledge of managed care industry **LICENSES AND CERTIFICATION** **Required** + Medical Doctor or ... need. **Preferred** + None **SKILLS** + Critical Thinking + Case Management + Customer Service + Oral...Skills + General Computer Skills + Clinical Software + Managed Care **Language (Other than English)** None… more
- Centene Corporation (Knoxville, TN)
- … care , social work, quality improvement or health coaching preferably in a managed care environment. 2+ years of experience work experience should be in ... customer service to resolve member issues. + Refers to case or disease management as appropriate. +...work, quality improvement or health coaching preferably in a managed care environment. **License/Certification:** One of the… more
- Gentiva (Dickson, TN)
- …patient care manager senior, hospice leadership jobs, RN leadership, home-based care oversight, hospice case management , Gentiva careers ReqID: ... experience + Knowledge of hospice principles, regulatory compliance, and managed care + Strong communication, collaboration, and...+ 7 Paid Holidays + Wellness Programs (Telemedicine, Diabetes Management , Joint & Spine Concierge Care ) +… more
- Elevance Health (Nashville, TN)
- …critical thinking skills and nursing judgment and experience. + Collaborates with case management nurses on discharge planning, ensuring patient has appropriate ... about plan benefits and physicians and may assist with case management . + Collaborates with leadership in...in nursing. + Requires a minimum of 4 years managed care experience and requires a minimum… more
- Sevita (Maryville, TN)
- …for each person served. + Maintains a functional understanding of funding, managed care requirements, and licensing requirements for each person served. ... for each person served. + Maintains a functional understanding of funding, managed care requirements, and licensing requirements for each person served.… more
- Vanderbilt University Medical Center (Nashville, TN)
- …Collaborate effectively with other VUMC departments including but not limited to Managed Care Services; Health Information Services; Pt. Accounting; VMG; Offices ... advance health and wellness through preeminent programs in patient care , education, and research. **Organization:** Utilization Management ...of Case Management and Social Work; Admitting; ED… more
- Humana (Nashville, TN)
- …and use of business metrics + Experience working with Case managers or Care managers on complex case management , including familiarity with social ... in teams focusing on quality management , utilization management , case management , discharge planning... care industry including Medicare Advantage and Managed Medicaid products, or other Medical management … more
- Humana (Nashville, TN)
- …and use of business metrics. + Experience working with Case managers or Care managers on complex case management , including familiarity with social ... of decisions to internal associates, and possible participation in care management . The clinical scenarios predominantly arise...in teams focusing on quality management , utilization management , case management , discharge planning… more
- Humana (Nashville, TN)
- …Substance Use Disorder Population. + Experience working with Case managers or Care managers on complex case management , including familiarity with social ... of decisions to internal associates, and possible participation in care management . The clinical scenarios arise from...in teams focusing on quality management , utilization management , case management , discharge planning… more
- CVS Health (Nashville, TN)
- …ourselves with dedicated colleagues who are passionate about transforming health care . As the nation's leading health solutions company, we reach millions ... with heart, each and every day. **Position Summary** The Population Health Management (PHM) Success Manager role supports Meritain Health's Population Health … more