- LifePoint Health (Gallatin, TN)
- … management or related healthcare field. **Job:** **Nursing* **Organization:** ** **Title:** * Utilization Mgmt Case Manager FT* **Location:** ... Monitors adherence to the hospital's utilization review plan to ensure appropriate use of...admissions and extended hospitals stays. Reports to: Director - Case Management Minimum Education Associate's, Bachelor's degree… more
- Molina Healthcare (Bowling Green, KY)
- …the pharmacy benefit changes for the upcoming year. + Works with the Case Management department as part of a member-centered interdisciplinary care team. ... (such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns and pharmacy costs management ), clinical pharmacy… more
- HCA Healthcare (Nashville, TN)
- …Bonus available for qualified RN candidates! Do you have the career opportunities as a Case Management RN you want in your current role? We invest in what ... Eligibility for benefits may vary by location. The RN Case Manager is responsible for promoting patient-centered...What you will do in this role: + Provides case management services for both inpatient and… more
- Cardinal Health (Nashville, TN)
- …get life-changing therapies to patients who need them-faster.** **_Responsibilities_** The Senior Case Manager supports patient access to therapy through patient ... guidance and training to junior case managers on best practices in case management , patient interaction, and navigating internal and external systems. +… more
- Highmark Health (Nashville, TN)
- …Inc. **Job Description :** **JOB SUMMARY** This job implements effective ** utilization management ** strategies including: review of appropriateness of health ... , identification of opportunities for referral to a Health Coach/ case management , and identification and resolution of...clinical care is being provided. **Preferred** + Certification in utilization management or a related field **SKILLS**… more
- Molina Healthcare (Bowling Green, KY)
- …in Clinical Program Evaluation + Experience in building clinical targeting models for Case Management + Experience or strong desire to learn Python/PySpark + ... needs. + Creates reporting for strategic analysis, profitability, financial analysis, utilization patterns and medical management . + Interfaces and maintains… more
- Omnicell (Nashville, TN)
- …number of strategic health-system existing customers. This is a strategic account management position. Accounts are target accounts that have a major strategic ... systems customers and ensure strategy is executed. Execute contract business case and account plans, detailing resources and contractual obligations, opportunities,… more
- Highmark Health (Nashville, TN)
- …Highmark Inc. **Job Description :** **JOB SUMMARY** This job implements effective complimentary utilization and case management strategies for an assigned ... and federal law standards and are within the care manager 's professional discipline. + For assigned case ...**Required** + 7 years in any combination of clinical, case / utilization management and/or disease/condition … more
- Evolent (Nashville, TN)
- …training classes as needed for new hires to educate and train on Utilization management system and Field Medical Director process, standards and resources. ... requested basis, reviews appeal cases and/or attends hearings for discussion of utilization management decisions. + Strong partnership with Physician Business… more
- Molina Healthcare (Bowling Green, KY)
- …Clinical Coder + Certified Medical Audit Specialist + Certified Case Manager + Certified Professional Healthcare Management + Certified Professional in ... Chief Medical Officer on denial decisions. + Resolves escalated complaints regarding Utilization Management and Long-Term Services & Supports issues. +… more
- Baker Construction (Nashville, TN)
- …in establishing clinics, managing first report of injuries, and assisting with co-worker case management + Follows Company Recruitment and Hiring Guidelines + ... and other reports + Alerts the Superintendent and Project Manager of project impact relating to resource management...utilization , MBE/SBE participation, etc., and advises the Project Manager of issues + Interfaces with Safety and Risk… more
- Elevance Health (Nashville, TN)
- …preferred. + Extensive orthopedic surgery experience preferred. + Experience with utilization management , especially with CMS guidelines preferred. For ... medical necessity of requests using clinical criteria. + Performs physician-level case review of musculoskeletal utilization requests. + Conducts peer-to-peer… more
- CDM Smith (Bowling Green, KY)
- …of cloud technologies, including design patterns, planning, configuration, and resource management in Microsoft Azure and other cloud platforms. * Develop DevSecOps ... (AAD), RBAC, IAM configuring role assignments, conditional access, and identity management . * Incorporate security best practices into cloud architecture and ensure… more
- SitusAMC (Nashville, TN)
- …and colleagues in terms of clients' inquiries, model implementation issues and utilization . + Provides internal support to peers including peer report reviews and ... etc. + Such other activities as may be assigned by your manager Qualifications/ Requirements: + Bachelor's Degree in finance, economics, statistics, or mathematics… more
- Evolent (Nashville, TN)
- …on value- based care and initiatives within pathway, policy, and beyond utilization management solutions. + Introduce innovative initiatives supported with ... for provider portal, prior authorizations, lists, regimens, scope diagnoses, case review and related activities. + Review of Carepro...serve as the clinical lead (SME) on the Rules Manager Team. + Ability to travel 15% for external… more