- Vanderbilt University Medical Center (Nashville, TN)
- …that the appropriate admission status is ordered. Conducts initial admission based on utilization review medical necessity criteria. Refers cases for secondary ... difficulty. * Clinical Applications Systems (Novice): Possesses fundamental proficiency in utilization review systems, clinical support systems and business… more
- Humana (Clarksville, TN)
- …Family Therapist **(LMFT)** , Licensed Professional Counselor **(LPC)** , Psychologist **(PhD)** , Registered Nurse **( RN )** or other professional license. + ... and external customers and stakeholders. **Preferred Qualifications** + Experience with utilization review process. + Experience with behavioral change, health… more
- LifePoint Health (Gallatin, TN)
- Monitors adherence to the hospital's utilization review plan to ensure appropriate use of hospital services , hospital admissions and extended hospitals ... to: Director - Case Management Minimum Education Associate's, Bachelor's degree or RN Diploma in Nursing - Required Required Skills Requires critical thinking… more
- Aveanna Healthcare (Franklin, TN)
- Hospice Registered Nurse RN Full Time ApplyRefer a FriendBack Job Details Requisition #: 204729 Location: Franklin, TN 37064 Category: Nursing Salary: $37.00 ... the plan of care and patient needs. + Participates in quality improvement, utilization review , and infection control activities as requested. + Attends… more
- Gallatin Center for Rehabilitation and Healing (Gallatin, TN)
- …meaningful contributions to the rehab team conferences, patient care conferences, utilization review meetings, family conferences, and caregiver training ... a week 37.5 - 40 hours per week Respiratory Nurse ( RN ) We are searching for a...and clinical code of ethics and practice. . Implementing in- services and training. . Maintaining a current body of… more
- Veterans Affairs, Veterans Health Administration (Nashville, TN)
- …located in Nashville, TN. Responsibilities The Nurse Referral Coordination Team (RCT) Registered Nurse ( RN )) is responsible for executing a streamlined ... intimate knowledge of the internal referral care process, clinical review criteria, utilization management standards, clinical documentation...Request for Services (RFS) to promote inhouse service access. The RCT RN will utilize… more
- Sharecare (Nashville, TN)
- …cost effective, appropriate resource utilization and quality outcomes. The Clinical Registered Nurse is also responsible for early identification of those ... for everyone. To learn more, visit www.sharecare.com . **Job Summary:** The Clinical Registered Nurse has the responsibility for supporting the goals and… more
- Vanderbilt University Medical Center (Nashville, TN)
- …emphasizing negative elements. **Position Qualifications:** **Responsibilities:** **Certifications:** LIC- Registered Nurse - Licensure-Others **Work ... 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… more
- HCA Healthcare (Nashville, TN)
- …Surgery Center have the opportunity to make a real impact. As an Operating Room Registered Nurse you can be a part of change. **Benefits** Centennial Surgery ... include: + Comprehensive medical coverage that covers many common services at no cost or for a low copay....positive outcomes for your patients as an Operating Room Registered Nurse . We want your knowledge and… more
- Sedgwick (Nashville, TN)
- …to ensure efficient, cost effective, and high quality delivery of case management and utilization review services to clients for multiple business lines; and ... to provide expertise in client specific case management and utilization review requirements and ensure customer satisfaction through the provision of these … more
- Highmark Health (Nashville, TN)
- …SUMMARY** This job implements effective ** utilization management** strategies including: review of appropriateness of health care services , application of ... of quality issues. Monitors and analyzes the delivery of health care services ; educates providers and members on a proactive basis; and analyzes qualitative… more
- Lincoln Financial (Nashville, TN)
- …as indicated **What we're looking for** * 4 Year/Bachelor's Degree in Nursing * Registered Nurse License - Current, unrestricted license in the state where the ... We are excited to bring on a highly motivated Nurse Disability Consultant to our clinical organization. This position...Trauma , Disability, Workman's comp or case management or Utilization review **Application Deadline** **What's it like… more
- Guardian Life (Nashville, TN)
- **Position Summary** The RN Clinical Consultant serves as a clinical resource for the investigation and assessment of medical information regarding disability by ... medical reviews and analysis of long-term disability claims. The RN Clinical Consultant identifies restrictions, limitations and duration impacting functional… more
- HCA Healthcare (Nashville, TN)
- …step in your career path, we encourage you to apply for our Case Management RN opening. We review all applications. Qualified candidates will be contacted by a ... **Description** 8k Sign-On Bonus available for qualified RN candidates! Do you have the career opportunities...a part of the nation's leading provider of healthcare services , HCA Healthcare. Benefits TriStar Skyline Medical Center, offers… more
- Highmark Health (Nashville, TN)
- …**Job Description :** **JOB SUMMARY** This job implements effective complimentary utilization and case management strategies for an assigned member panel. Provides ... to appropriate resources for additional support. + Implement care management review processes that are consistent with established industry, corporate, state, and… more
- Evolent (Nashville, TN)
- …Required and Preferred:** + Current, unrestricted state licensure as a Registered Nurse - **Required** + **California or Oregon License Required** ... and analyzes clinical record documentation in order to approve services that meet clinical review criteria. +...+ Associate or Bachelors in Nursing (Must be a Registered Nurse ) - **Required** + You must… more
- HCA Healthcare (Nashville, TN)
- …outcomes. What Qualification you will need: + Associates Degree or Higher Required + Registered Nurse in any state + Clinical/healthcare experience, minimum of 2 ... include: + Comprehensive medical coverage that covers many common services at no cost or for a low copay....3% to 9% of pay (based on years of service ) + Employee Stock Purchase Plan with 10% off… more
- Evolent (Nashville, TN)
- …focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and procedures ... work with a group of nurses, providing appeal intake review for one dedicated client. They interact with coordinators...Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to company… more
- Fresenius Medical Center (Springfield, TN)
- …dialysis clinic. You will collaborate with the Medical Director and the Charge Nurse regarding the provision of quality patient care in the dialysis clinic. ... direct reports. + Partners with internal Human Resources, Quality, and Technical Services departments. + Collaborates with the Home Therapies Manager to oversee the… more