- Humana (Nashville, TN)
- …part of our caring community and help us put health first** The SNF Utilization Management Nurse uses clinical knowledge, communication skills, and ... receives guidance where needed. Follows established guidelines and procedures. The SNF Utilization Management Nurse uses clinical knowledge, communication… more
- CVS Health (Nashville, TN)
- …Must have active current and unrestricted RN licensure in state of residence. + Utilization Management is a 24/7 operation and work schedules will include ... med surg or specialty area. + Managed Care experience preferred, especially Utilization Management . + Preference for those residing in EST and CST zones.… more
- HCA Healthcare (Nashville, TN)
- …of nursing experience required + 1-4 years of relevant case management / utilization review experience preferred + Registered Nurse - Currently licensed as ... **Description** **Introduction** Do you have the career opportunities as a(an) Utilization Review Services RN you want with your current employer? We have an… more
- Ascension Health (Nashville, TN)
- **Details** + **Department:** Utilization Management + **Schedule:** Monday - Friday. 40 hours a week. + **Hospital:** Ascension Saint Thomas + **Location:** ... be located with in the TN market. We're looking for an experienced Director of Utilization Management to join our team! In this pivotal role, you'll lead… more
- Humana (Nashville, TN)
- …a part of our caring community and help us put health first** The Utilization Management (UM) Director, Clinical Strategy and Practice for Medicaid builds ... of how organization capabilities interrelate across the function or segment. The Utilization Management (UM) Director, Clinical Strategy and Practice for… more
- Zurich NA (Nashville, TN)
- …+ Experience in development and implementation of cost containment programs + Case management , utilization review, catastrophic or disability experience + 5 or ... AVP, Utilization Review & Pharmacy 123092 Zurich Insurance is...recruiting and retaining team members. + Drive the performance management process by communicating job expectations, monitoring and evaluating… more
- Humana (Clarksville, TN)
- …us put health first** Humana Healthy Horizons in Kentucky is seeking a Utilization Management Behavioral Health Professional 2 who utilizes behavioral health ... and communication of medical services and/or benefit administration determinations. The Utilization Management Behavioral Health Professional 2 work assignments… more
- Veterans Affairs, Veterans Health Administration (Nashville, TN)
- …knowledge of the internal referral care process, clinical review criteria, utilization management standards, clinical documentation requirements, community care ... Summary This position is located in Nashville, TN. Responsibilities The Nurse Referral Coordination Team (RCT) Registered Nurse (RN)) is responsible for… more
- Evolent (Nashville, TN)
- …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and client policies and ... the culture. **What You'll Be Doing:** The Evolent Appeals Nurse team offers candidates the opportunity to make a...and regulations. * Practices and maintains the principles of utilization management and appeals management … more
- HCA Healthcare (Bowling Green, KY)
- …effective labor management , including position control, scheduling excellence, productivity management , and premium pay utilization to maintain staffing to ... colleagues invested over 156,000 hours impacting our communities. As a Medical Surgical Nurse Director with TriStar Greenview Regional Hospital, you can be a manager… more
- Select Medical (Nashville, TN)
- …such as medication errors, falls, and hospital-acquired pressure ulcers. Champions nurse -driven protocols to decrease urinary catheter utilization rates and ... Hospital** **Select Specialty Hospital - Nashville** **Advanced Practice Registered Nurse / APRN** **Full-Time Hours** **Location:** **2000 Hayes Street, Suite… more
- Select Medical (Nashville, TN)
- …such as medication errors, falls, and hospital-acquired pressure ulcers. Champions nurse -driven protocols to decrease urinary catheter utilization rates and ... **Overview** **Critical Illness Revovery Hospital** **Advanced Practice Registered Nurse / APRN** **PRN - As Needed Position** **_Hours will be available on… more
- Molina Healthcare (Bowling Green, KY)
- …Chief Medical Officer on denial decisions. + Resolves escalated complaints regarding Utilization Management and Long-Term Services & Supports issues. + ... as may be required. + Serves as a clinical resource for Utilization Management , Chief Medical Officer, Physicians, and Member/Provider Inquiries/Appeals. +… more
- Sharecare (Nashville, TN)
- …total healthcare management and ensure cost effective, appropriate resource utilization and quality outcomes. The Clinical Registered Nurse is also ... the participants and their Primary Care Provider according to the disease management program intervention guidelines. A Clinical Registered Nurse is supervised… more
- Highmark Health (Nashville, TN)
- …Nursing **EXPERIENCE** **Required** + 7 years in any combination of clinical, case/ utilization management and/or disease/condition management experience, or ... on where clinical care is being provided. **Preferred** + Certification in utilization management or a related field + Certification in Case Management … more
- Gallatin Center for Rehabilitation and Healing (Gallatin, TN)
- Schedule . 5 days a week 37.5 - 40 hours per week Respiratory Nurse (RN) We are searching for a highly motivated, flexible, organized, skilled respiratory therapist ... meaningful contributions to the rehab team conferences, patient care conferences, utilization review meetings, family conferences, and caregiver training sessions. +… more
- Evolent (Nashville, TN)
- …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and ... **What You Will Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to company policies and… more
- Jennie Stuart Medical Center, Inc. (Hopkinsville, KY)
- …taking vital signs, starting IV and drawing blood, vaginal exams, pain management and obtaining pertinent information and able to document in McKesson/OB Trace ... of care set by state board of nursing, state nurse practice act, and other governing agency regulations. Resolving...care Delegates duties based on complexity of patient needs Utilization of critical thinking skills in prioritization of care… more
- Community Health Systems (Antioch, TN)
- …and monitors team goals, delegates effectively. + Monitors and ensures effective utilization of equipment and staff within the Transfer Center. + Trains, develops, ... + Strong knowledge of hospital transfer processes, patient flow management , and healthcare operations. + Excellent interpersonal and communication skills,… more
- Vanderbilt University Medical Center (Nashville, TN)
- …or actions might be indicated * Experience/proficiency in the review and the utilization of EPIC and/or eStar including the Media tab, Care Everywhere, StarPanel, ... dot phrases, message basket management , and sending communications * Experience/proficiency in the use of Excel, Microsoft Teams, Adobe Acrobat, RightFax, and OnBase… more