- BlueCross BlueShield of Tennessee (Nashville, TN)
- …this position\. + This job requires digital literacy assessment\. **Job Qualifications** _License_ + Registered Nurse \( RN \) with active license in the state ... sickle cell, brain injuries, oncology\-related needs\)\. **Job Responsibilities** + Supporting utilization management functions for more complex and non\-routine… more
- BlueCross BlueShield of Tennessee (Nashville, TN)
- …this position\. + This job requires digital literacy assessment\. **Job Qualifications** _License_ + Registered Nurse \( RN \) with active license in the state ... meet their complex needs\. As a Care Transition Case Manager , you will play a vital role in ensuring...have you on our team\. **Job Responsibilities** + Supporting utilization management functions for more complex and… more
- Vanderbilt University Medical Center (Nashville, TN)
- …through preeminent programs in patient care, education, and research. **Organization:** Utilization Management **Job Summary:** Coordinate, monitor, and evaluate ... the operation of Utilization Management Section of the Utilization Management Department of the Medical Center. . KEY RESPONSIBILITIES + Develop work… more
- Select Medical (Nashville, TN)
- …by doing what is right. The Case Manager is responsible for utilization reviews and resource management , discharge planning, treatment plan management ... current licensure in a clinical discipline either as a Nurse ( RN /LPN/LVN) or a Respiratory Therapist (RT)...the plan of care. + Demonstrates compliance with facility-wide Utilization Management policies and procedures. + Coordinates… more
- Select Medical (Nashville, TN)
- …by doing what is right. The Case Manager is responsible for utilization reviews and resource management , discharge planning, treatment plan management ... the plan of care. + Demonstrates compliance with facility-wide Utilization Management policies and procedures. + Coordinates...**Current licensure in a clinical discipline either as a Nurse ( RN /LPN/ LVN)or a Respiratory Therapist… more
- CenterWell (Nashville, TN)
- … RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to ... put health first** Conviva Care Solutions is seeking a RN who will collaborate with other health care givers...DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous… more
- Elevance Health (Nashville, TN)
- …I** The Behavioral Health Care Manager I is responsible for conducting utilization management reviews for mental health and substance use disorder inpatient ... provide an equivalent background. + Current active unrestricted license, such as ** RN LCSW** **LMSW LMHC** **LPC** (as allowed by applicable state laws) **LMFT**… more
- HCA Healthcare (Nashville, TN)
- …Centennial Medical Center have the opportunity to make a real impact. As a(an) Case Manager RN you can be a part of change. **Benefits** TriStar Centennial ... location._** It is an exciting time to be a nurse at HCA Healthcare! Come unlock your career potential...positive outcomes for your patients as a (an) Case Manager RN . We want your knowledge and… more
- HCA Healthcare (Nashville, TN)
- **Description** **Introduction** Do you have the PRN career opportunities as a(an) Case Manager RN PRN you want with your current employer? We have an exciting ... colleagues. Do you want to work as a(an) Case Manager RN PRN where your passion for...stay, managing the length of stay, ensuring appropriate resource management and developing a safe appropriate discharge plan in… more
- Molina Healthcare (Bowling Green, KY)
- …and/or coding experience, or equivalent combination of relevant education and experience. + Registered Nurse ( RN ). License must be active and unrestricted ... ensure appropriate reimbursement to providers. + Resolves escalated complaints regarding utilization management and long-term services and supports (LTSS)… more
- Molina Healthcare (Bowling Green, KY)
- …health, pharmacy, etc.), or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... **JOB DESCRIPTION** **Job Summary** The Clinical Appeals Nurse ( RN ) provides support for internal...officer on denial decisions. * Resolves escalated complaints regarding utilization management and long-term services and supports… more
- Humana (Nashville, TN)
- …concerns.** **Use your skills to make an impact** **Required Qualifications** + **Active Registered Nurse ( RN ) Multi-state/Compact State license with no ... caring community and help us put health first** The Nurse Advice Line is a fast-paced inbound call center...care, skilled or rehabilitation setting, home health, DME, triage, utilization , or case management . + **Ability to… more
- Community Health Systems (Clarksville, TN)
- …platforms, healthcare software systems, and data analysis tools. **Licenses and Certifications** + RN - Registered Nurse - State Licensure and/or Compact ... **Job Summary** The Supervisor, House - RN provides critical leadership during assigned shifts to...coordinates admissions, discharges, and transfers, and ensures optimal bed utilization . + Acts as the administrative point of contact… more
- Elevance Health (Clarksville, TN)
- …unless an accommodation is granted as required by law._ The **LTSS Service Coordinator- RN ** is responsible for overall management of member's case within the ... **LTSS Service Coordinator - RN ** **Location:** The location for this position includes Knox, Anderson, Claiborne, Williamson, Davidson, Montgomery, Shelby, Tipton,… more
- Molina Healthcare (Bowling Green, KY)
- …transitions, behavioral health, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ), Licensed Vocational Nurse (LVN), ... years in one or more of the following areas: utilization management , care management , care...online portals and databases. Preferred Qualifications * Certified Case Manager (CCM), Certified Professional in Healthcare Management … more
- Molina Healthcare (Bowling Green, KY)
- …transitions, behavioral health, or equivalent combination of relevant education and experience. + Registered Nurse ( RN ), Licensed Vocational Nurse (LVN), ... years in one or more of the following areas: utilization management , care management , care...online portals and databases. **Preferred Qualifications** + Certified Case Manager (CCM), Certified Professional in Healthcare Management … more
- Sharecare (Nashville, TN)
- …appropriate resource utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during their interactions with participants ... program intervention guidelines. A Disease Management Nurse is supervised by an Operations Manager ...with disabilities to perform the essential functions. + Current Registered Nurse multi-state compact license in the… more
- Deloitte (Nashville, TN)
- …as clinical registered nurse , physician, physician assistant, case manager , clinical documentation specialist, utilization review, informatics RN , ... Bachelor's degree in nursing, medical degree, or physician assistant required + Current Registered Nurse ( RN ) license required + Certified Clinical… more
- STG International (Hopkinsville, KY)
- …the management /coordination of the clinic's day-to-day activity, in conjunction with the Registered Nurse ( RN )/CBOC Manager and VA Program's ... to ensure compliance and patient safety. * Participates in quality improvement, care management , risk management , peer review, utilization review, clinical… more
- Elevance Health (Nashville, TN)
- **Medical Management Nurse ** **Hours: 8am-6pm flexible start time** **Location** : This role enables associates to work virtually full-time, with the exception ... accommodation is granted as required by law. The **Medical Management Nurse ** is responsible for review of...in multiple states. **Preferred Skills, Capabilities & Experiences:** + Utilization management experience. + Strong of computer… more
