• Clinical Compliance

    Highmark Health (Nashville, TN)
    …Description :** **JOB SUMMARY** This job is responsible for working with HHO clinical departments in the areas of compliance and process improvement. Serves ... as a corporate resource regarding accreditation standards, clinical performance and continuous improvement...maintenance of Care Management policies and procedures to ensure accreditation and compliance with NCQA and DMMA… more
    Highmark Health (06/28/25)
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  • Coordinator Medical Staff Services WFH

    HCA Healthcare (Nashville, TN)
    …want to join an organization that invests in you as a Medical Staff Services Coordinator ? At Work from Home, you come first. HCA Healthcare has committed up to $300 ... make a difference. We are looking for a dedicated Coordinator for Medical Staff Services like you to be...review for new applicants and re-applicants for membership and/or clinical privileges completed by the Credentialing Processing Center (CPC),… more
    HCA Healthcare (07/04/25)
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  • Case Manager - Oncology, Transplant or Specialty…

    CVS Health (Nashville, TN)
    …clients. + Application and/or interpretation of applicable criteria and clinical guidelines, standardized care management plans, polices, procedures and regulatory ... and/or member's needs to ensure appropriate administration of benefits. + Applies clinical judgment to the incorporation of strategies designed to reduce risk… more
    CVS Health (06/21/25)
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  • Registered Nurse, Case Manager - Oncology…

    CVS Health (Nashville, TN)
    …clients - Application and/or interpretation of applicable criteria and clinical guidelines, standardized care management plans, polices, procedures and regulatory ... and/or member's needs to ensure appropriate administration of benefits - Applies clinical judgment to the incorporation of strategies designed to reduce risk factors… more
    CVS Health (06/19/25)
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  • Telephonic Nurse Case Manager

    Humana (Nashville, TN)
    …to maximize each beneficiary's capacity for self-care, to cost-effectively achieve desired clinical outcomes and to enhance quality of medical care. The case manager ... of case management involvement. The case manager will serve as the primary coordinator and point of contact for the beneficiary for all activities within the… more
    Humana (07/01/25)
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  • Program Analyst

    Veterans Affairs, Veterans Health Administration (Nashville, TN)
    …plans for complex research studies/project for completeness, accuracy and ensures compliance with local and federal policies and regulations. Incumbent assigns ... the scientific methodology associated with the research project and the clinical and/or scientific expertise of the committee members ensuring the protection… more
    Veterans Affairs, Veterans Health Administration (07/03/25)
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