- Community Health Systems (Franklin, TN)
- **Job Summary** The Clinical Utilization Review Specialist is responsible for evaluating the necessity, appropriateness, and efficiency of hospital ... collaborates with healthcare providers to facilitate efficient patient care. The Clinical Utilization Review Specialist monitors adherence to hospital… more
- YesCare Corp (Brentwood, TN)
- …standards of best practice. + Facilitate quality health care intervention recommendations. + Review and assess over/under utilization issues. + Track, trend and ... a pioneer in correctional healthcare services, YesCare is committed to innovation, clinical expertise, and compassionate care. By choosing a career with YesCare, you… more
- Cognizant (Nashville, TN)
- …and retro-authorization as well as timely filing deadlines and processes. . Review clinical denials including but not limited to referral, preauthorization, ... determinations to the Health Plan/Medical Director based on the review of clinical documentation in accordance with...background - Registered Nurse (RN) . 2-3 years combined clinical and utilization management experience with managed… more
- HCA Healthcare (Nashville, TN)
- …face or telemedicine assessment completed and physician consult. + Provides a thorough clinical review and risk assessment with appropriate level of care ... treatment is reimbursed by contacting managed care organizations and completing initial utilization review . Documents in Midas as required. Involves mobile… more
- HCA Healthcare (Nashville, TN)
- …operations, policies, systems and procedures necessary to support cost reduction and system utilization goals. + Provide monthly KPI's for review and regular ... Do you want to join an organization that invests in you as a Sr Specialist Workforce Planning and Integration? At HCA Healthcare, you come first. HCA Healthcare has… more
- HCA Healthcare (Nashville, TN)
- …you want to join an organization that invests in you as a Sr. Specialist Labor Performance Improvement? At HCA Healthcare, you come first. HCA Healthcare has ... a difference. We are looking for a dedicated Sr. Specialist Labor Performance Improvement like you to be a...Develops processes to support improved operations (such as sitter utilization , use of various pay codes, overtime management, etc.)… more
- Prime Therapeutics (Nashville, TN)
- …and drives every decision we make. **Job Posting Title** Customer Care Specialist **Job Description** This position is a front-line service position providing ... into the appropriate delivery system to initiate the EAP, Care and Utilization management programs. + Demonstrates flexibility in areas such as job duties… more
- HCA Healthcare (Nashville, TN)
- …join an organization that invests in you as an Expanse Professional Development Specialist ? At HealthTrust, you come first. HCA Healthcare has committed up to $300 ... We are looking for a dedicated Expanse Professional Development Specialist like you to be a part of our...includes the educational aspects of orientation and onboarding of clinical employees and development of education that addresses EHR… more
- Evolent (Nashville, TN)
- …when available, within the regulatory timeframe of the request. + Utilizes medical/ clinical review guidelines and parameters to assure consistency in the ... make a meaningful impact on patient care in a non- clinical setting? Join our Utilization Management team... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more