- Humana (Nashville, TN)
- …of action. The Utilization Management Nurse 2/Home Health Utilization Management : + Review cases using clinical knowledge, communication skills, ... part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination,… more
- Elevance Health (Nashville, TN)
- **Clinical Operations Medical Director** ** Utilization Management of Medical Oncology Benefits** **Carelon Benefits Management ** **$20,000 Sign On Bonus** ... members and providers. **Job Summary:** + Perform physician-level case review , following initial nurse review ,...maintain knowledge of relevant policies and regulations pertaining to utilization review of oncology care. + Participate… more
- Humana (Nashville, TN)
- … management personnel and oversee all utilization management functions, including inpatient admissions, concurrent review , prior authorization, and ... put health first** Humana Healthy Horizons in Virginia is seeking a Manager, Utilization Management (Behavioral Health) who will utilize their clinical skills to… 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)
- …of our caring community and help us put health first** The Manager, Utilization Management Nursing uses clinical knowledge, communication skills, and independent ... the daily management and operations of the department. Oversees utilization management functions which include timely authorizations related to… more
- Elevance Health (Nashville, TN)
- …**How you will make an impact:** + Develops, maintains and enhances the claims review process. + Assists management with developing unit goals, policies and ... ** Nurse Audit Lead** **Supports the Carelon Payment Integrity...responsible for identifying, monitoring, and analyzing aberrant patterns of utilization and/or fraudulent activities by health care providers through… more
- Elevance Health (Brentwood, TN)
- ** Nurse Reviewer I** **Location:** Within 50 miles of...hospital setting or minimum of 1 year of prior utilization management , medical management and/or ... state(s) required. **Preferred Skills, Capabilities, and Experiences:** + Familiarity with Utilization Management Guidelines, ICD-10 + Previous utilization … more
- The Cigna Group (Nashville, TN)
- …care or community setting + Minimum of two years of experience in Case Management or Utilization Review + Experience with physician's office practices ... and ensure end of life preferences are identified + Review recent admission trends and history with PCP and...MSSP regulations + HIPAA regulations + Knowledge of care management - utilization management , discharge planning, population… more
- Aveanna (Franklin, TN)
- …the plan of care and patient needs. + Participates in quality improvement, utilization review , and infection control activities as requested. + Attends ... Hospice Registered Nurse RN Full Time 10K Sign On Bonus...** Position Overview TheHospice Registered Nurseis responsible for pain management , symptom control in the delivery of care to… more
- Vanderbilt University Medical Center (Nashville, TN)
- …if additional records requests or actions might be indicated * Experience/proficiency in the review and the utilization of EPIC and/or eStar including the Media ... the VPEC OHO Clinic * Comfortable with the clinical review of testing results and visit plans to determine...tab, Care Everywhere, StarPanel, dot phrases, message basket management , and sending communications * Experience/proficiency in the use… more
- Nashville Center for Rehabilitation and Healing (Nashville, TN)
- …trends on a monthly basis + Responsible for timely and accurate completion of Utilization Review and Triple Check + Serves on, participates in, and attends ... and ensures that appropriate follow-up action is taken + Facilitates the Care Management Process engaging the resident, IDT and family in timely identification and… more
- Fresenius Medical Center (Antioch, TN)
- …auditing activities. + Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. + Manages clinic ... financials including efficient utilization of supplies or equipment and regular profits and...of supplies or equipment and regular profits and loss review . + Responsible for all required network reporting and… more
- Marriott (Nashville, TN)
- …with Claims department regarding case management . + Collaborate with UNM on utilization review issues. + Refer catastrophic cases in coordination with claims ... claims most likely to benefit from case management to meet jurisdictional needs. ** Utilization Review ** + Provide initial clinical review in order to… more
- HCA Healthcare (Nashville, TN)
- …this opportunity compelling, we encourage you to apply for our Manager Case Management opening. We promptly review all applications. Highly qualified candidates ... where diversity and inclusion thrive? Submit your application for our Manager Case Management opening with HCA Healthcare today and find out what it truly means… more
- HCA Healthcare (Nashville, TN)
- …opportunity to make a real impact. As a VP of Clinical Resource and Account Management you can be a part of change. **Benefits** HealthTrust, offers a total rewards ... location._** It is an exciting time to be a nurse at HCA Healthcare! Come unlock your career potential...patients as a VP of Clinical Resource and Account Management . We want your knowledge and expertise! **Job Summary… more
- HCA Healthcare (Nashville, TN)
- …patient throughput while supporting a balance of optimal care and appropriate resource utilization . Provides case management services for both inpatient and ... continue to learn! **Job Summary and Qualifications** The Registered Nurse (RN) CM is responsible for promoting patient-centered care...you, we encourage you to apply for our Case Management RN opening. Our team will promptly review… more
- HCA Healthcare (Brentwood, TN)
- …labor management , including position control, scheduling excellence, productivity management , and premium pay utilization . Maintains staffing to ensure ... Director Clinical Education Programs is responsible for the collaborative development, management and delivery and execution of clinical education programs for HCA's… more
- Vanderbilt University Medical Center (Nashville, TN)
- …for the PCC. * Lead activities related to performance, improvement, and risk management programs in order to establish and meet clinical quality goals, effective ... cost management , patient satisfaction, and business goals. * Participates in...or VUMC goals. * Promote and monitor the effective utilization of the assigned space in support of the… more
- HCA Healthcare (Nashville, TN)
- …improvement opportunities to enhance the effectiveness and efficiency of the competency management program through the review of evidence for best practices ... department performance in accordance with established budget, including the utilization of staffing, supplies, and equipment identifying cost reduction opportunities… more
- HCA Healthcare (Nashville, TN)
- …and performance of assigned home health care team(s) Supervises ongoing case management of all patients ensuring an accurate evaluation and treatment plan, ... clinicians regarding deficiencies or OASIS corrections (with feedback from Quality Review Specialist) to ensure the medical records reflect compliance with medical… more