- 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 ... in med surg or specialty area, + Managed Care experience preferred, especially Utilization Management , + Preference for those residing in ET and CT time zones,… more
- Humana (Nashville, TN)
- …of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- HCA Healthcare (Nashville, TN)
- … nursing experience required + 1-4 years of relevant case management / utilization review experience preferred + Registered Nurse - Currently licensed as a ... **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
- Baylor Scott & White Health (Nashville, TN)
- **LOCATION:** Remote **SPECIALTY/DEPARTMENT:** Care Management : Case Management Utilization Management Appeals or grievances **SHIFT/SCHEDULE:** ... on position type and/or level **Job Summary** A Registered Nurse in Nursing Professional Development Generalist role...IN ONE OR MORE OF THE FOLLOWING SPECIALITIES:** **Case Management ** ** Utilization Management ** **Appeals or… more
- Community Health Systems (Franklin, TN)
- … preferred + 2-4 years of clinical experience in utilization review, case management , or acute care nursing required + 1-3 years work experience in care ... and efficiency of hospital services to ensure compliance with utilization management policies. This role conducts admission...Nursing required + Bachelor's Degree in Nursing… more
- CenterWell (Nashville, TN)
- …of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- Humana (Nashville, TN)
- …**Key Functions:** **Strategic Planning and Implementation:** + Develop and implement utilization management strategies that align with organizational goals. + ... care. **Cost Containment:** + Identify opportunities for cost savings through effective utilization management practices. + Monitor and analyze utilization … more
- Evolent (Nashville, TN)
- …As a Clinical Reviewer, Nurse , you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... are supported by Field Medical Directors (MDs) in the utilization management determination process. + Reviews charts...**Qualifications:** + Current, unrestricted state licensure as a Registered Nurse + Associate or Bachelors in Nursing … more
- Humana (Nashville, TN)
- …course of action. **Key Functions:** + Serves as a liaison between Humana utilization management (UM) operations, Humana's Risk and Compliance lines of defense, ... regarding prior authorization reviews, prepayment retrospective reviews, and any additional utilization management functions. + Develop and implement … more
- CVS Health (Nashville, TN)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... in **Specialty Pharmacy or Oncology.** **Preferred Qualifications** + 1+ years' Case Management experience or discharge planning, nurse navigator or nurse… more
- CVS Health (Nashville, TN)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... using a keyboard **Preferred Qualifications** - 1+ years' Case Management experience or discharge planning, nurse navigator...lower levels of care - 1+ years' experience in Utilization Review - CCM and/or other URAC recognized accreditation… more
- Humana (Nashville, TN)
- …interpretation skills, with prior experience participating in teams focusing on quality management , utilization management , case management , discharge ... Integrated Delivery Systems, health insurance, other healthcare providers, clinical group practice management . + Utilization management experience in a… more
- Highmark Health (Nashville, TN)
- …Inc. **Job Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of health ... depending on where clinical care is being provided. **Preferred** + Certification in utilization management or a related field **SKILLS** + Working knowledge of… more
- HCA Healthcare (Nashville, TN)
- …required (LPC, LMFT, LCSW, LADAC) + Previous experience in Needs Assessment and Utilization Management strongly preferred. + Familiarity with required DSM V-R ... nurses play a vital part. We know that every nurse 's path and purpose is unique. Do you want...want to create your own personal career path in nursing ? HCA Healthcare is your career destination! Our scale… more
- BlueCross BlueShield of Tennessee (Nashville, TN)
- …Chattanooga, TN, this is a fully remote role\. **Job Responsibilities** + Supporting utilization management functions for more complex and non\-routine cases as ... BlueCross BlueShield of Tennessee \(BCBST\) is seeking a skilled and compassionate Registered Nurse with a strong background in case management to join our… more
- Dialysis Clinic, Inc. (Nashville, TN)
- …conjunction with Senior Operations Directors, helps to manage financial outcomes, supply utilization , labor management , contract management , and clinical ... in collaboration with Corporate Department of Education and Quality Management . + Presents at AOD and Nurse ...with Corporate Home Nurses, CMO of Home, and Chief Nursing Officer to facilitate improvement as needed. + Consults… more
- Veterans Affairs, Veterans Health Administration (Nashville, TN)
- …registration will meet the requirement for graduation from an approved school of professional nursing to warrant an appointment as a Nurse who has completed an ... Degree (ADN) or Diploma in Nursing , with no additional professional nursing required. Nurse I, Level II Demonstrates integration of biopsychosocial concepts,… more
- Sedgwick (Nashville, TN)
- …satisfaction; to ensure efficient, cost effective, and high quality delivery of case management and utilization review services to clients for multiple business ... lines; and to provide expertise in client specific case management and utilization review requirements and ensure...territory of the United States required. Certification in case management required. Bachelor's degree in nursing (BSN)… more
- Sharecare (Nashville, TN)
- …total healthcare management and ensure cost effective, appropriate resource utilization and quality outcomes. The Clinical Registered Nurse is also ... and their Primary Care Provider according to the disease management program intervention guidelines. A Clinical Registered Nurse...Hours are on Central Standard Time. _ A compact nursing license is required for this position_ **Essential Job… more
- Vanderbilt University Medical Center (Nashville, TN)
- … Officer - Vanderbilt Transplant Center and Vanderbilt Lung Institute. The Associate Nursing Officer shall provide general management for the operations of a ... programs in patient care, education, and research. **Organization:** Adult Amb Nursing Admin **Job Summary:** The Vanderbilt Health Executive Search Team is… more