- Community Health Systems (Franklin, TN)
- …Knowledge of HIPAA regulations and patient confidentiality standards. **Licenses and Certifications** + RN - Registered Nurse - State Licensure and/or ... **Job Summary** The Part-Time Clinical Utilization Review Specialist is responsible for evaluating the necessity, appropriateness, and efficiency of hospital… more
- Ascension Health (Nashville, TN)
- …Provide health care services regarding admissions, case management, discharge planning and utilization review . + Review admissions and service requests ... planning needs with healthcare team members. + May prepare statistical analysis and utilization review reports as necessary. + Oversee and coordinate compliance… more
- YesCare Corp (Brentwood, TN)
- …+ Assist in completion of special projects on an as needed basis. **Key Qualifications:** + Registered Nurse ( RN ) active license + No less than 5 years' ... lives through care and expertise. **Key Responsibilities:** + The nurse will focus on what's best for the patients...practice. + Facilitate quality health care intervention recommendations. + Review and assess over/under utilization issues. +… more
- Humana (Nashville, TN)
- …an impact** **Use your skills to make an impact** **Required Qualifications** + **Licensed Registered Nurse ( RN )** in the (appropriate state) with no ... caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing...in an acute care setting + Previous experience in utilization management/ utilization review for a… more
- CVS Health (Nashville, TN)
- …+ Perform medical necessity reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse with at least 1 year of experience in a hospital ... setting. + A Registered Nurse that holds an active, unrestricted...lower levels of care. + 1+ years' experience in Utilization Review . + CCM and/or other URAC… more
- Cognizant (Nashville, TN)
- …to be considered** . Educational background - Registered Nurse ( RN ) . 2-3 years combined clinical and/or utilization management experience with managed ... Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact...as well as timely filing deadlines and processes. . Review clinical denials including but not limited to referral,… more
- Wellpath (Franklin, TN)
- …or Care Management Certification + RN preferred EXPERIENCE + Previous utilization review and/or case management and pre-certification experience + Knowledge ... make a difference** The Regional Care Manager (RCM) is responsible for utilization review , care coordination, and daily care management across multiple sites and… more
- HCA Healthcare (Nashville, TN)
- …treatment is reimbursed by contacting managed care organizations and completing initial utilization review . Documents in Midas as required. Involves mobile ... nurses play a vital part. We know that every nurse 's path and purpose is unique. Do you want...patients in regard to managed care organizations + Conducts utilization review for managed care cases in… more
- Elevance Health (Nashville, TN)
- …4 years managed care experience and requires a minimum of 2 years clinical, utilization review , or case management experience; or any combination of education ... is granted as required by law. The **Medical Management Nurse ** is responsible for review of the...an equivalent background. + Current active, valid and unrestricted RN license and/or certification to practice as a health… more
- Humana (Nashville, TN)
- …of employment + 3 years clinical RN experience + 2 years of Utilization Review , Case Management, or Quality Management experience + Strong analytical skills, ... Coordinates case presentations and presents to Patient Safety Peer Review Committee. Audits quality cases for compliance and participates...+ Active licensed RN in state… more
- HCA Healthcare (Nashville, TN)
- …satisfaction and personal growth, we encourage you to apply for our Case Manager RN PRN opening. We review all applications. Qualified candidates will be ... have the PRN career opportunities as a(an) Case Manager RN PRN you want with your current employer? We...supporting a balance of optimal care and appropriate resource utilization . What you will do in this role: +… more
- HCA Healthcare (Nashville, TN)
- …and personal growth, we encourage you to apply for our Operating Room RN opening. We promptly review all applications. Highly qualified candidates will ... integrity. We care like family! Jump-start your career as an Operating Room RN today with Centennial Surgery Center. **Benefits** Centennial Surgery Center offers a… more
- HCA Healthcare (Nashville, TN)
- …to join an organization that invests in you as a Clinical Appeals Specialist Medicare RN or LPN? At Parallon, you come first. HCA Healthcare has committed up to $300 ... are looking for a dedicated Clinical Appeals Specialist Medicare RN or LPN like you to be a part...today! What you will do in this role: + Review medical records and other documentation to compose RAC… more
- Datavant (Nashville, TN)
- …with clinical knowledge and expertise successfully. Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well versed in DRG downgrade ... of the Denial Prevention Specialist is to effectively defend utilization of available health services, review of...by management Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well… more
- Highmark Health (Nashville, TN)
- …years of experience in Managed Care **LICENSES or CERTIFICATIONS** **Required** + Registered Nurse **Preferred** + Certified Medical Coder or related **SKILLS** ... and the proper action to complete the retrospective claim review with the goal of proper and timely payment...data to assure appropriate level of payment and resource utilization . It is also used to identify issues which… more
- Sharecare (Nashville, TN)
- …to enable individuals with disabilities to perform the essential functions. + Current Registered Nurse multi-state compact license in the state in which they ... utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during their interactions with participants for identification… more
- HCA Healthcare (Nashville, TN)
- …or instruction of Clinical EHR application - Required + Currently licensed as a registered nurse or allied health professional in the state(s) in which he ... department performance in accordance with established budget, including the utilization of staffing, supplies, and equipment identifying cost reduction opportunities… 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
- Parexel (Nashville, TN)
- …reproducible research practices like version control and literate programming. + BSN, RN , RPh, Pharm D, PA, MPH, or other applicable health professional credentials, ... solutions, and ensure high-quality, compliant data. + Use surveillance tools to review data at an aggregate level, identifying patterns or anomalies to ensure… more
- HCA Healthcare (Nashville, TN)
- …personal growth, we encourage you to apply for our Cardiology Clinical Research Nurse opening. We promptly review all applications. Highly qualified candidates ... We care like family! Jump-start your career as a Clinical Research Nurse today with TriStar Centennial Medical Center. **Benefits** TriStar Centennial Medical Center… more