- The Cigna Group (Nashville, TN)
- …related issues, implications and decisions. The Case Management Analyst reports to the Supervisor/ Manager of Appeals and will coordinate and perform all appeal ... **Cigna Medicare Part C Appeals Reviewer: Appeals Processing Analyst** We...as well as research and provide a written detailed clinical summary for the Plan Medical Director. + Determine… more
- LifePoint Health (Pulaski, TN)
- …level of care for each patient, including participation in the Clinical Documentation Program Facilitate Discharge Planning through team collaboration for each ... in statistical tracking and reporting of the Utilization Management metrics. Facilitates appeals of denials as needed, including analysis and corrective actions for… more
- Sharecare, Inc. (Nashville, TN)
- …available 3rd parties for care management and second opinion. + Referring members to Clinical Advocates ( Nurse ) for conditions that require clinical care and ... enrollment / new hire plan selection, claims issues, ID card issues, grievances/ appeals , utilization management (UM) status, including but not limited to medical,… more
- BlueCross BlueShield of Tennessee (Nashville, TN)
- …LMSW, or LAPSW\) OR Registered Nurse \(RN\) OR Licensed Practical Nurse \(LPN\) _Experience_ + 3 years \- Clinical experience required ... coordinators to promote interdependent collaboration with the member, physician/primary care manager , family, and other members of the care/support coordination team… more