- HCA Healthcare (Nashville, TN)
- …**Introduction** Do you want to join an organization that invests in you as a Case Management Managed Care Consultant? At HCA Healthcare, you ... like you to be a part of our team. **Job Summary and Qualifications** The Case Management Managed Care Consultant will serve as a Subject Matter Advisor… more
- Elevance Health (Nashville, TN)
- **Manager II Case Management ** **Sign on Bonus: $5000** **Location** : This role requires associates to be in-office 3 days per week, fostering collaboration and ... Friday 8 - 5 pm EST.** The **Manager II Case Management ** is responsible for managing a...health or human services related field is preferred. + Managed Care experience is preferred. Please be… more
- Humana (Nashville, TN)
- … Management Team, providing a comprehensive, holistic approach for case management throughout the continuum of care . The case manager will offer ... the Case Manager will collaborate with other care management programs until the beneficiary's needs...delivery system. + Knowledge of MCG or Interqual. + Managed care experience. **Additional Information** **Work Days/Hours**… more
- Cardinal Health (Nashville, TN)
- …long and short-range changes in the reimbursement environment including Medicare, Medicaid, Managed Care , and Commercial medical and pharmacy plans while ... Patient Support helps specialty pharmaceutical manufacturers remove barriers to care so that patients can access, afford and remain...junior case managers on best practices in case management , patient interaction, and navigating internal… more
- Cardinal Health (Nashville, TN)
- …Remain knowledgeable about changes in the reimbursement environment (Medicare, Medicaid, Managed Care , Commercial plans). **Program Expertise & Continuous ... . Build and maintain professional relationships with all stakeholders, including case management , patient support services, medical, sales, market access,… more
- Health Care Service Corporation (Nashville, TN)
- …cases. + Certification in Case Management , Training, Project Management or nationally recognized health care certification. + Government Programs ... care coordination to members via telephonic and/or field-based care management to inform and educate them...days of hire. + Plus 3 years' wellness or managed care experience presenting clinical issues with… more
- Molina Healthcare (Bowling Green, KY)
- …, including at least 1 year of experience in a direct patient care , and/or managed care , care management , or behavioral health setting, or equivalent ... support for health management activities within the care management / care coordination functions. Collaborates...Qualifications **LVN is preferred for this role.** * Certified Case Manager (CCM). To all current Molina employees: If… more
- Humana (Nashville, TN)
- …and use of business metrics. + Experience working with Case managers or Care managers on complex case management , including familiarity with social ... of decisions to internal associates, and possible participation in care management . May occasionally participate in discussions...in teams focusing on quality management , utilization management , case management , discharge planning… more
- Highmark Health (Nashville, TN)
- …Description :** **JOB SUMMARY** This job implements effective complimentary utilization and case management strategies for an assigned member panel. Provides ... member. The incumbent conducts outreach to members enrolled in case management including but is not limited...in a clinical setting **Preferred** + 5 years in UM/CM/QA/ Managed Care + 1 year in advanced… more
- Highmark Health (Nashville, TN)
- …in Medical Management in a Health Insurance Plan; strong knowledge of managed care industry **LICENSES AND CERTIFICATION** **Required** + Medical Doctor or ... need. **Preferred** + None **SKILLS** + Critical Thinking + Case Management + Customer Service + Oral...Skills + General Computer Skills + Clinical Software + Managed Care **Language (Other than English)** None… more
- Elevance Health (Nashville, TN)
- …critical thinking skills and nursing judgment and experience. + Collaborates with case management nurses on discharge planning, ensuring patient has appropriate ... about plan benefits and physicians and may assist with case management . + Collaborates with leadership in...in nursing. + Requires a minimum of 4 years managed care experience and requires a minimum… more
- Vanderbilt University Medical Center (Nashville, TN)
- …Collaborate effectively with other VUMC departments including but not limited to Managed Care Services; Health Information Services; Pt. Accounting; VMG; Offices ... advance health and wellness through preeminent programs in patient care , education, and research. **Organization:** Utilization Management ...of Case Management and Social Work; Admitting; ED… more
- Humana (Nashville, TN)
- …and use of business metrics + Experience working with Case managers or Care managers on complex case management , including familiarity with social ... in teams focusing on quality management , utilization management , case management , discharge planning... care industry including Medicare Advantage and Managed Medicaid products, or other Medical management … more
- Humana (Nashville, TN)
- …and use of business metrics. + Experience working with Case managers or Care managers on complex case management , including familiarity with social ... of decisions to internal associates, and possible participation in care management . The clinical scenarios predominantly arise...in teams focusing on quality management , utilization management , case management , discharge planning… more
- Humana (Nashville, TN)
- …Substance Use Disorder Population. + Experience working with Case managers or Care managers on complex case management , including familiarity with social ... of decisions to internal associates, and possible participation in care management . The clinical scenarios arise from...in teams focusing on quality management , utilization management , case management , discharge planning… more
- CenterWell (Nashville, TN)
- …experienceparticipatingin teams focusing on transitions of care , quality management ,utilizationmanagement, case management , discharge planning and/or ... of daily work, communication of decisions to internal associates, participation in care management and possible participation in care facilitation… more
- Valor Health (Bowling Green, KY)
- …solution focused counseling, education and referral for resources and benefits, and case management . Develops program content and organizes & leads activities ... continuity of care through the PCMM (Primary Care Management Module). + Evaluates patients records...patients utilizing rules set forth by the VA for co- managed care . + Conducts individual, group, and… more
- Valor Health (Bowling Green, KY)
- …solution focused counseling, education and referral for resources and benefits, and case management . Develops program content and organizes & leads activities ... continuity of care through the PCMM (Primary Care Management Module). + Evaluates patients records...patients utilizing rules set forth by the VA for co- managed care . + Conducts individual, group, and… more
- Molina Healthcare (Bowling Green, KY)
- …a Medical Director in clinical practice * 3 years' experience in Utilization/Quality Program Management * 2+ years HMO/ Managed Care experience * Experience ... Summary** Molina's Behavioral Health function provides leadership and guidance for utilization management and case management programs for mental health… more
- Humana (Nashville, TN)
- …industry. + Minimum 3 years of experience in data analytics, clinical operations, care management , quality improvement, or vendor oversight. + Proficient in ... + Advanced Degree (such as MSN, MBA, MHA, MPH). + Experience in managed care , health plan operations, or Medicare Advantage programs (including various… more