- Humana (Clarksville, TN)
- …help us put health first** Humana Healthy Horizons in Kentucky is seeking a Utilization Management Behavioral Health Professional 2 who utilizes ... and communication of medical services and/or benefit administration determinations. The Utilization Management Behavioral Health Professional… more
- HCA Healthcare (Nashville, TN)
- …services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed ... 1-4 years of nursing experience required + 1-4 years of relevant case management / utilization review experience preferred + Registered Nurse - Currently licensed… more
- Highmark Health (Nashville, TN)
- …of clinical, case/ utilization management and/or disease/condition management experience, or provider operations and/or health insurance experience ... health status/severity and clinical needs; and assesses health management needs of the assigned member...clinical care is being provided. **Preferred** + Certification in utilization management or a related field +… more
- Highmark Health (Nashville, TN)
- …Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of health care services, ... utilization , identification of opportunities for referral to a Health Coach/case management , and identification and resolution...position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of… more
- HCA Healthcare (Nashville, TN)
- …services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed ... want to join an organization that invests in you as a Manager Equipment Management Operations? At HealthTrust, you come first. HCA Healthcare has committed up to… more
- Elevance Health (Nashville, TN)
- …chronically ill patients, chronically ill pediatric patients, and patients with IDD. + Home Health , Utilization Management or Case Management experience ... care plans by educating members regarding clinical needs and facilitating referrals to health professionals for behavioral health needs. + Uses motivational… more
- Elevance Health (Nashville, TN)
- …A proud member of the Elevance Health family of companies, Carelon Behavioral Health , formerly Beacon Health Options, offers superior clinical mental ... preferred. + Extensive orthopedic surgery experience preferred. + Experience with utilization management , especially with CMS guidelines preferred. For… more
- Highmark Health (Nashville, TN)
- …:** **JOB SUMMARY** This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and ... (DO) **Substitutions** + None **Preferred** + Master's Degree in Business Administration/ Management or Public Health **EXPERIENCE** **Required** + 5 years… more
- HCA Healthcare (Nashville, TN)
- …services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed ... fully insured premiums and ASO administration expense for medical, dental, absence management , wellness vendor, Health Reimbursement Accounts (HRA), vision, LTD,… more
- HCA Healthcare (Nashville, TN)
- …services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free Air Med ... Do you have the career opportunities as a Case Management RN you want in your current role? We...Center, offers a total rewards package that supports the health , life, career and retirement of our colleagues. The… more
- Highmark Health (Nashville, TN)
- **Company :** Highmark Health **Job Description :** **JOB SUMMARY** This job will manage small scale projects and enhancement packages with mentorship and leadership ... from more senior Delivery Owners. The incumbent provides project management leadership and facilitates the delivery of system changes from approval through to… more
- Highmark Health (Nashville, TN)
- …**Job Description :** **JOB SUMMARY** This job provides application software development management for IT projects. Creates plans and manages activities, within an ... available options, comparing costs and benefits, and recommending solutions. 2 Management Consulting + Identify issues and recommend solutions. + Create presentation… more
- Highmark Health (Nashville, TN)
- …portfolio of AI-powered products, including a core administrative platform, modular utilization and care management solutions, patient-focused digital products, ... Marketing qualified leads and sales qualified leads. + Opportunity Pipeline Management : Manage and forecast the sales pipeline, providing accurate revenue… more
- Highmark Health (Nashville, TN)
- …familiarity with key domains like CMS interoperability, Quality management , care & utilization management , and digital health + 3 years' experience in ... brand visibility, market intelligence, etc.) + Proposal & RFP Management : + Support proposal development timelines, coordinate input across...from lead to closure) + 3 years' experience in Health Plan Technology + 3 years' experience with solid… more
- Highmark Health (Nashville, TN)
- **Company :** Highmark Health **Job Description :** **JOB SUMMARY** This job is a strong advocate of cloud technology and engineering support necessary to drive the ... to senior or lead engineers to further cloud service utilization and optimization. + Develops automation scripts and other...of action. + Level 2 Incident, problem and change management as it pertains to the responsibilities of the… more
- Highmark Health (Nashville, TN)
- …knowledge of clinical, quality, care, utilization , high-cost claim, and population health management . Must be a recognized subject matter expert (SME). + ... job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of...with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as… more
- BlueCross BlueShield of Tennessee (Nashville, TN)
- …travel for face\-to\-face meetings with members\. **Job Responsibilities** + Supporting utilization management functions for more complex and non\-routine cases ... clinical expertise in caring for medically fragile children with complex medical and/or behavioral health needs\. The Nurse Care Manager will assess for child… more
- CenterWell (Nashville, TN)
- …care that affect patient care and population management , such as quality management , utilization management , network management , and payment ... that impact patient well-being. Our integrated care teams, which include physicians, nurses, behavioral health specialists and more, spend up to 50 percent more… more
- HCA Healthcare (Nashville, TN)
- …services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed ... TriStar Centennial Medical Center, offers a total rewards package that supports the health , life, career and retirement of our colleagues. The available plans and… more
- HCA Healthcare (Nashville, TN)
- …services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed ... **Responsibilities:** + Develops processes to support improved operations (such as sitter utilization , use of various pay codes, overtime management , etc.) in… more