- Prisma Health (Maryville, TN)
- …care and timely implementation of plan of care in accordance with hospital(s) Utilization Review Plan and CMS regulation. Maintains expert level knowledge of body ... regarding payor and regulatory guidelines. Promotes effective and efficient utilization of clinical resources, ensuring quality, cost effective care. Provides… more
- Cognizant (Nashville, TN)
- …to be considered** . Educational background - Registered Nurse ( RN ) . 2-3 years combined clinical and/or utilization management experience with managed ... Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact...care revenue cycle or clinic operations . Experience in utilization management to include Clinical Appeals and Grievances, precertification,… more
- Veterans Affairs, Veterans Health Administration (Johnson City, TN)
- …equivalent to a bachelor's level degree in Nursing may have opportunity to become registered as a nurse with a state licensing board prior to completion ... Summary The UM Nurse shares the responsibility for planning, implementation, and...reviews. VA offers a comprehensive total rewards package: VA Nurse Total Rewards Pay: Competitive salary, regular salary increases,… more
- Fresenius Medical Center (Winchester, TN)
- …Classification of Disease (ICD) coding. + Manages clinic financials including efficient utilization of supplies or equipment and regular profits and loss review. + ... of education and experience. + Graduate of an accredited School of Nursing ( RN ). + Current appropriate state licensure. **EXPERIENCE AND SKILLS:** + Required: + 6+… more
- CVS Health (Nashville, TN)
- …+ Perform medical necessity reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse with at least 1 year of experience in a hospital ... is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that...setting. + A Registered Nurse that holds an active, unrestricted… more
- Select Medical (Nashville, TN)
- …mechanical ventilation liberation rates. **Qualifications** Minimum requirements: + Permanent State Registered Nurse License and Certificate of Authority. + ... such as medication errors, falls, and hospital-acquired pressure ulcers. Champions nurse -driven protocols to decrease urinary catheter utilization rates and… more
- Vanderbilt University Medical Center (Nashville, TN)
- …emphasizing negative elements. **Position Qualifications:** **Responsibilities:** **Certifications:** LIC- Registered Nurse - Licensure-Others **Work ... to impact pediatric patients and families from the beginning - Autonomy and Utilization of Critical Skills - Teamwork that displays comradery and family center care… more
- Quality Center for Rehabilitation and Healing (Lebanon, 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 ... meaningful contributions to the rehab team conferences, patient care conferences, utilization review meetings, family conferences, and caregiver training sessions. +… more
- Humana (Nashville, TN)
- …Standard Time **Required Qualifications** + Minimum of Associate Degree in nursing + Licensed Registered Nurse ( RN ) in a compact state with no disciplinary ... us put health first** Full-Time, Remote Telephonic opportunity The Utilization Management Nurse 2 utilizes clinical nursing...determination of the appropriate courses of action. As a Utilization Management RN working on the OneHome/Home… more
- YesCare Corp (Brentwood, TN)
- …+ Assist in completion of special projects on an as needed basis. **Key Qualifications:** + Registered Nurse ( RN ) active license + No less than 5 years' ... that is transforming lives through care and expertise. **Key Responsibilities:** + The nurse will focus on what's best for the patients within assigned contracts and… more
- Humana (Nashville, TN)
- …an impact** **Use your skills to make an impact** **Required Qualifications** + **Licensed Registered Nurse ( RN )** in the (appropriate state) with no ... caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing...Greater than one year of clinical experience in a RN role in acute care setting with preference for… more
- Humana (Nashville, TN)
- …guidelines/procedures. **Use your skills to make an impact** **Required Qualifications** + Licensed Registered Nurse ( RN ) in the (appropriate state) with no ... 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)
- …to make an impact** **Required Qualifications** + Minimum of an Associate's degree + Licensed Registered Nurse ( RN ) with no disciplinary action + Minimum 2 ... our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination,… more
- Ascension Health (Nashville, TN)
- …rules and regulations. **Requirements** Licensure / Certification / Registration: + Licensed Registered Nurse credentialed from the Tennessee Board of Nursing or ... health care services regarding admissions, case management, discharge planning and utilization review. + Review admissions and service requests within assigned unit… more
- Community Health Systems (Franklin, TN)
- …Knowledge of HIPAA regulations and patient confidentiality standards. **Licenses and Certifications** + RN - Registered Nurse - State Licensure and/or ... **Job Summary** The Part-Time Clinical Utilization Review Specialist is responsible for evaluating the...and efficiency of hospital services to ensure compliance with utilization management policies. This role conducts admission and continued… more
- CVS Health (Nashville, TN)
- …+ Active and good standing Arizona clinical and/or counseling license, specifically RN ( Registered Nurse ), LPC (Licensed Professional Counselor), LAC ... skills to coordinate, document, and communicate all aspects of the utilization /benefit management program. + Conduct clinical reviews for adult inpatient behavioral… more
- Covenant Health Inc. (Knoxville, TN)
- Overview Registered Nurse Care Manager, Continuum of Care Full Time, 80 Hours Per Pay Period , Day Shift M-F. May rotate weekend and minor holidays. Parkwest ... of Care Department is staffed by a Manager, Coordinator, RN Care Managers, and Masters Level Social Workers. They...management services within the scope of practice as a registered nurse meeting all required standards both… more
- Covenant Health Inc. (Lenoir City, TN)
- Overview Registered Nurse Care Manager, Quality Management PRN/OCC,Hours and Shifts Vary Fort Loudoun Medical Center Overview: Fort Loudoun Medical Center is ... care to every patient, every time. Position Summary: The RN Care Manager II is responsible for integrating evidenced...management services within the scope of practice as a registered nurse meeting all required standards both… more
- Covenant Health Inc. (Knoxville, TN)
- Overview Registered Nurse Care Manager, Social Services PRN/OCC, Variable Hours and Shifts Fort Sanders Regional Overview: Fort Sanders Regional Medical Center ... and recovery procedures for hip patients. Position Summary: The RN Care Manager III is responsible for integrating evidenced...management services within the scope of practice as a registered nurse meeting all required standards both… more
- Covenant Health Inc. (Knoxville, TN)
- Overview Registered Nurse Care Coordinator, Quality Management Full Time, 80 Hours Per Pay Period, Day Shift About Us Covenant Medical Group employs or manages ... a proud member of Covenant Health! Position Summary: The RN Care Coordinator II is responsible for integrating evidenced...coordination services within the scope of practice as a registered nurse meeting all required standards both… more
