- HCA Healthcare (Nashville, TN)
- **Description** **Introduction** Do you have the career opportunities as a(an) Utilization Review Services RN you want with your current employer? We ... of colleagues. Do you want to work as a(an) Utilization Review Services RN...+ 1-4 years of relevant case management/ utilization review experience preferred + Registered Nurse… more
- LifePoint Health (Gallatin, TN)
- Monitors adherence to the hospital's utilization review plan to ensure appropriate use of hospital services , hospital admissions and extended hospitals ... to: Director - Case Management Minimum Education Associate's, Bachelor's degree or RN Diploma in Nursing - Required Required Skills Requires critical thinking… more
- Humana (Nashville, TN)
- …your skills to make an impact** **Required Qualifications** + Compact licensure + Licensed Registered Nurse ( RN ) in the (appropriate state) with no ... of our caring community and help us put health first** The SNF Utilization Management Nurse uses clinical knowledge, communication skills, and independent… more
- Molina Healthcare (Bowling Green, KY)
- **JOB DESCRIPTION** Opportunity for experienced Utilization Review RN in United States who has a compact, multi-state license. This team reviews the prior ... for internal meetings. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse ( RN ). **Required Experience** 1-3 years of… more
- Gallatin Center for Rehabilitation and Healing (Gallatin, TN)
- …meaningful contributions to the rehab team conferences, patient care conferences, utilization review meetings, family conferences, and caregiver training ... a week 37.5 - 40 hours per week Respiratory Nurse ( RN ) We are searching for a...and clinical code of ethics and practice. . Implementing in- services and training. . Maintaining a current body of… more
- Community Health Systems (Antioch, TN)
- …regulatory requirements related to patient care and data privacy. **Licenses and Certifications** + RN - Registered Nurse - State Licensure and/or Compact ... a Supervisor of the Transfer Center at Access Center Services you'll join a team and be a part...coaches, and develops staff members to provide high quality service and to grow in their capabilities. + Monitors… more
- Veterans Affairs, Veterans Health Administration (Nashville, TN)
- …located in Nashville, TN. Responsibilities The Nurse Referral Coordination Team (RCT) Registered Nurse ( RN )) is responsible for executing a streamlined ... intimate knowledge of the internal referral care process, clinical review criteria, utilization management standards, clinical documentation...Request for Services (RFS) to promote inhouse service access. The RCT RN will utilize… more
- Molina Healthcare (Bowling Green, KY)
- …supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and Support, or other specific program experience as needed ... outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse ( RN ) performs clinical/medical reviews of previously denied… more
- Sharecare (Nashville, TN)
- …cost effective, appropriate resource utilization and quality outcomes. The Clinical Registered Nurse is also responsible for early identification of those ... for everyone. To learn more, visit www.sharecare.com . **Job Summary:** The Clinical Registered Nurse has the responsibility for supporting the goals and… more
- Vanderbilt University Medical Center (Nashville, TN)
- …emphasizing negative elements. **Position Qualifications:** **Responsibilities:** **Certifications:** LIC- Registered Nurse - Licensure-Others **Work ... if additional records requests or actions might be indicated * Experience/proficiency in the review and the utilization of EPIC and/or eStar including the Media… more
- HCA Healthcare (Nashville, TN)
- …treatment is reimbursed by contacting managed care organizations and completing initial utilization review . Documents in Midas as required. Involves mobile ... flexibility and supports changes that improve quality of care, service and operations. + RN 's Only -...patients in regard to managed care organizations + Conducts utilization review for managed care cases in… more
- Sedgwick (Nashville, TN)
- …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 customer satisfaction through the provision of these … more
- Highmark Health (Nashville, TN)
- …SUMMARY** This job implements effective ** utilization management** strategies including: review of appropriateness of health care services , application of ... of quality issues. Monitors and analyzes the delivery of health care services ; educates providers and members on a proactive basis; and analyzes qualitative… more
- HCA Healthcare (Nashville, TN)
- …step in your career path, we encourage you to apply for our Case Management RN opening. We review all applications. Qualified candidates will be contacted by a ... **Description** 8k Sign-On Bonus available for qualified RN candidates! Do you have the career opportunities...a part of the nation's leading provider of healthcare services , HCA Healthcare. Benefits TriStar Skyline Medical Center, offers… more
- HCA Healthcare (Bowling Green, KY)
- …and personal growth, we encourage you to apply for our Operating Room RN opening. We promptly review all applications. Highly qualified candidates will ... like family! Jump-start your career as a(an) Operating Room RN today with Greenview Surgery Center. **Benefits** Greenview Surgery...include: + Comprehensive medical coverage that covers many common services at no cost or for a low copay.… more
- Highmark Health (Nashville, TN)
- …**Job Description :** **JOB SUMMARY** This job implements effective complimentary utilization and case management strategies for an assigned member panel. Provides ... to appropriate resources for additional support. + Implement care management review processes that are consistent with established industry, corporate, state, and… more
- Evolent (Nashville, TN)
- …focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and procedures ... work with a group of nurses, providing appeal intake review for one dedicated client. They interact with coordinators...Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to company… more
- Fresenius Medical Center (Springfield, TN)
- …dialysis clinic. You will collaborate with the Medical Director and the Charge Nurse regarding the provision of quality patient care in the dialysis clinic. ... direct reports. + Partners with internal Human Resources, Quality, and Technical Services departments. + Collaborates with the Home Therapies Manager to oversee the… more