- Humana (Nashville, TN)
- **Become a part of our caring community and help us put health first** The Medical Director relies on medical background and reviews health claims. The ... Medical Director work assignments involve moderately complex to complex issues...work is assisted by diverse resources which may include national clinical guidelines, CMS policies and determinations, clinical reference… more
- Evolent (Nashville, TN)
- …Tasks are performed within the RN/LVN/LPN scope of practice, under Medical Director direction, using independent nursing judgement and decision-making, ... that do not meet established clinical criteria to the Medical Director . + Appropriately identifies and refers.... + Appropriately identifies and refers quality issues to UM Leadership. + Appropriately identifies potential cases for Care… more
- YesCare Corp (Brentwood, TN)
- …and maintain pre-established review parameters under the direction of the YesCare Medical Director . + Identify and document comparisons with community standards, ... specific time frame to ensure resources are maximized. + Work with other UM inpatient and outpatient nurse reviewers to assure proper treatment in the appropriate… more