- 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 ... 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 ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- Humana (Nashville, TN)
- …Work hours will be an 8.5-hour shift between 7:00am - 5:00pm CST. The Utilization Management Nurse 2 uses knowledge, communication, and independent critical ... Qualifications** + Associate's Degree or higher + Licensed Registered Nurse (RN) in the (appropriate state) with no disciplinary...a team **Preferred Qualifications** + BSN + Knowledge of Utilization Management + Previous Medicare and Medicaid… 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
- CenterWell (Nashville, TN)
- …RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability ... Therapy, DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare… 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
- Cognizant (Nashville, TN)
- …background - Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management experience with managed health care plan . 3 years' experience ... 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 Appeals and… more
- CenterWell (Nashville, TN)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and ... **Required Qualifications** + Must be a licensed Registered Compact Nurse license (RN) with no disciplinary action and ability...volume and fast paced environment + Previous experience in utilization management + Education: BSN or bachelor's… more
- Humana (Nashville, TN)
- **Become a part of our caring community and help us put health first** The Utilization Management Behavioral Health Nurse 2 utilizes clinical nursing skills ... and communication of behavioral health services and/or benefit administration determinations. The Utilization Management Behavioral Health Nurse 2 work… more
- YesCare Corp (Brentwood, TN)
- …as indicated. + Communicate and guide staff and physicians regarding utilization management program development, implementation, and evaluation and ... lives through care and expertise. **Key Responsibilities:** + The nurse will focus on what's best for the patients...license + No less than 5 years' experience in utilization management , case management , quality… 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
- Elevance Health (Nashville, TN)
- **Medical Management Nurse ** **Hours: 8am-6pm flexible start time** **Location** : This role enables associates to work virtually full-time, with the exception ... accommodation is granted as required by law. The **Medical Management Nurse ** is responsible for review of...in multiple states. **Preferred Skills, Capabilities & Experiences:** + Utilization management experience. + Strong of computer… more
- Sharecare (Nashville, TN)
- …appropriate resource utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during their interactions with participants ... for everyone. To learn more, visit www.sharecare.com . **Job Summary:** The Disease Management Nurse has the responsibility for supporting the goals and… more
- Humana (Nashville, TN)
- …experience in an acute care, skilled or rehabilitation setting, home health, DME, triage, utilization , or case management . + **Ability to work ANY 8-hour shift ... caring community and help us put health first** The Nurse Advice Line is a fast-paced inbound call center...+ Bachelor's degree in nursing (BSN) + Previous case management , utilization review, or triage experience +… more
- Select Medical (Memphis, TN)
- **Overview** **Position:** Nurse Manager- Registered Nurse (RN) **Location:** Memphis, TN (Inside of Methodist University Hospital) **Schedule:** Full-time ... of the most vulnerable, painful moments of their lives - and the Nurse Manager plays a central role in providing compassionate, excellent treatment and leadership… more
- Highmark Health (Nashville, TN)
- …Nursing **EXPERIENCE** **Required** + 7 years in any combination of clinical, case/ utilization management and/or disease/condition management experience, or ... within the first 6 months of employment. **Preferred** + Certification in utilization management or a related field + Certification in Case Management … more
- Elevance Health (Nashville, TN)
- …with providers, claims or service issues. + Assists with development of utilization /care management policies and procedures. **Minimum Requirements:** + Requires ... ** Nurse Case Manager II** **Work Schedule** **: M-F... Case Manager I** I is responsible for care management within the scope of licensure for members with… 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
- Covenant Health Inc. (Alcoa, TN)
- …Assures that productivity targets are met. + Coordinates the utilization management plan for physicians and nurse practitioners with the providers and ... and family therapy + Care Coordination + Support Groups + Medication management + Assessment and referral services Position Summary: Oversees the provision of… 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