• BlueCross BlueShield of Tennessee (Chattanooga, TN)
    …18 month commitment before posting for other internal positions\. **Job Qualifications** _License_ + Registered Nurse \( RN \) with active license in the state ... BCBST as a Clinical Review Manager\!** In this role, you will complete medical reviews for utilization management within the BlueCare member population\. You'll… more
    DirectEmployers Association (10/17/25)
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  • RN - UM / Medical

    Elevance Health (Nashville, TN)
    RN - Utilization / Medical Management Nurse / InPatient (JR171072) **Work Hours** : 8 hour shift within 8am - 6pm PST. Rotating Weekends and holidays. ... 8am - 6pm PST. Rotating Weekends and holidays. The ** Medical Management Nurse ** is responsible...an equivalent background. + Current active, valid and **unrestricted RN license** to practice as a health professional within… more
    Elevance Health (10/22/25)
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  • Registered Nurse Case Manager PRN…

    Vanderbilt University Medical Center (Nashville, TN)
    …negative elements. **Position Qualifications:** **Responsibilities:** **Certifications:** LIC- Registered Nurse - Licensure-OthersLicensure-Others **Work ... is located in Medical Center North, on campus serving VUMC. Transition management or commonly referred to as care coordination is a thriving department comprised… more
    Vanderbilt University Medical Center (08/01/25)
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  • UM Case Manager

    Healthfirst (TN)
    …Services (CMS) or New York State Department of Health (NYSDOH) regulations governing medical management in managed care** + **Relevant clinical work experience** ... team in order to maximize HF member care quality while achieving effective medical cost management ** + **Assists in identifying opportunities for and… more
    Healthfirst (10/23/25)
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  • Utilization Management Nurse - Home…

    Humana (Nashville, TN)
    …of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are varied and frequently require ... courses of action. As a Utilization Management RN working on the OneHome/Home Solutions UM ...+ Minimum of Associate Degree in nursing + Licensed Registered Nurse ( RN ) in a… more
    Humana (09/12/25)
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  • Care Manager RN - (Remote)

    Highmark Health (Nashville, TN)
    UM /CM/QA/Managed Care **LICENSES AND CERTIFICATIONS** **Required** + Current RN state licensure required. Additional specific state licensure(s) may be required ... **Job Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of health care services,… more
    Highmark Health (10/22/25)
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  • Clinical Reviewer, Nurse -9am -6pm PST

    Evolent (Nashville, TN)
    …+ Performs other duties as assigned. **The Experience You'll Need (Required):** + Registered Nurse or Licensed Practical/Vocational Nurse with a current, ... precertification and prior approvals. Tasks are performed within the RN /LVN/LPN scope of practice, under Medical Director...care + Minimum of one year of experience with medical management activities in a managed care… more
    Evolent (10/21/25)
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  • Telephonic Nurse Case Manager

    Humana (Nashville, TN)
    …**Required Qualifications** + Bachelor's degree in Nurse (BSN). + Valid and unrestricted Registered Nurse ( RN ) license in the (appropriate state) with no ... achieve desired clinical outcomes and to enhance quality of medical care. The **Telephonic Nurse Case Manager**...behavioral health spectrum. They will also coordinate with other Medical Management programs (DM/PN) as needed, in… more
    Humana (10/23/25)
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  • Clin Nurse III

    Covenant Health Inc. (Sevierville, TN)
    …maintain Tennessee State RN licensure. CPR required Apply/Share Job Title CLIN NURSE III ID 4104211 Facility LeConte Medical Center Department Name CRITICAL ... Overview Registered Nurse , Critical Care PRN/OCC, Variable Hours, Day Shift LeConte Medical Center Overview: LeConte Medical Center is a part of Covenant… more
    Covenant Health Inc. (10/21/25)
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  • Transplant Care Nurse - Remote

    Highmark Health (Nashville, TN)
    …:** **JOB SUMMARY** This job implements effective complimentary utilization and case management strategies for an assigned member panel. Provides oversight over a ... in health status/severity and clinical needs; and assesses health management needs of the assigned member panel and utilizing...in a clinical setting **Preferred** + 5 years in UM /CM/QA/Managed Care + 1 year in advanced training and… more
    Highmark Health (10/10/25)
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  • Behavioral Health Care Manager II - Licensed…

    Elevance Health (Nashville, TN)
    …to medically necessary behavioral healthcare in a cost-effective setting in accordance with UM Clinical Guidelines and contract. + Refers cases to Peer Reviewers as ... equivalent background. + Current active unrestricted license such as RN , LCSW, LMSW, LMHC, LPC, LBA (as allowed by...is licensed staff supervision. + Previous experience in case management /utilization management with a broad range of… more
    Elevance Health (10/13/25)
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