- BlueCross BlueShield of Tennessee (Chattanooga, TN)
- …as 4 years of professional work experience in a corporate environment\. + **Licensure:** Registered Nurse \(RN\) with active license in the state of Tennessee or ... + 5 years - progressive leadership experience in care management , utilization management , clinical operations,...+ Analytical: Strong business acumen with sound analytical skills Registered Nurse with BSN highly preferred\. Managed… more
- Cognizant (Nashville, TN)
- …- Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management experience with managed health care plan . 3 years' experience in ... 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… 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...Duties include: - Works with the medical center's Quality Management office to promote quality in the Medical Center… more
- Humana (Nashville, TN)
- …community and help us put health first** Full-Time, Remote Telephonic opportunity The Utilization Management Nurse 2 utilizes clinical nursing skills to ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...+ Minimum of Associate Degree in nursing + Licensed Registered Nurse (RN) in a compact state… 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
- 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 ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...Qualifications** + Minimum of an Associate's degree + Licensed Registered Nurse (RN) with no disciplinary action… more
- YesCare Corp (Brentwood, TN)
- …as indicated. + Communicate and guide staff and physicians regarding utilization management program development, implementation, and evaluation and ... projects on an as needed basis. **Key Qualifications:** + Registered Nurse (RN) active license + No...license + No less than 5 years' experience in utilization management , case management , quality… 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
- CVS Health (Nashville, TN)
- …and good standing Arizona clinical and/or counseling license, specifically RN ( Registered Nurse ), LPC (Licensed Professional Counselor), LAC (Licensed Associate ... experience working within the mental health system. + Previous experience with utilization management . + Ability to collaborate with various internal… 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 ... + Perform medical necessity reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse with at least 1 year of experience in a hospital… more
- Community Health Systems (Franklin, TN)
- …appropriateness, and efficiency of hospital services to ensure compliance with utilization management policies. This role conducts admission and continued ... admissions and extended stays, identifying opportunities for process improvements to enhance utilization management . + Serves as a key contact for facility… 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
- Ascension Health (Nashville, TN)
- …and coordinate compliance to federally mandated and third party payer utilization management rules and regulations. **Requirements** Licensure / Certification ... offer._ **Responsibilities** Provide health care services regarding admissions, case management , discharge planning and utilization review. +.../ Registration: + Licensed Registered Nurse credentialed from the Tennessee Board… 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 therapist ... meaningful contributions to the rehab team conferences, patient care conferences, utilization review meetings, family conferences, and caregiver training sessions. +… 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. + ... + Preferred but not required: + 3+ years supervisory or project/program management experience. + Med/surg or ICU/CCU experience. **PHYSICAL DEMANDS AND WORKING… more
- Sharecare (Nashville, TN)
- …appropriate resource utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during their interactions with participants ... learn more, visit www.sharecare.com . **Job Summary:** The Disease Management Nurse has the responsibility for supporting...with disabilities to perform the essential functions. + Current Registered Nurse multi-state compact license in the… more
- HCA Healthcare (Hendersonville, TN)
- …actively engaging interdisciplinary teams and external stakeholders. The Director is a registered nurse with responsibility for all operational aspects of the ... degree in Nursing, Health Administration, or Business Administration, preferred + Either Registered Nurse (RN) licensure, Licensed Clinical Social Worker (LCSW)… 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 ... reports directly to the Manager/Coordinator of Quality and Care Management at the facility level. Recruiter: Sandra Simmons ||... 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, Continuum of Care Full Time, 80 Hours Per Pay Period , Day Shift M-F. May rotate weekend and minor holidays. Parkwest ... with a minimum of 3 years of experience. Case Management certification is preferred, but not required. There is... services within the scope of practice as a registered nurse meeting all required standards both… more
- BlueCross BlueShield of Tennessee (Chattanooga, TN)
- BlueCross BlueShield of Tennessee \(BCBST\) is seeking a skilled and compassionate Registered Nurse to join our fast\-paced, high\-performing team\. In this ... care are essential for success in this role\. **Job Responsibilities** + Supporting utilization management functions for more complex and non\-routine cases as… more
