- CenterWell (Nashville, TN)
- …our caring community and help us put health first** The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and independent critical ... **Required Qualifications** + Must be a licensed Registered Compact Nurse license (RN) with no disciplinary action and ability...Lung or Critical Care Nursing experience required + Prior clinical experience preferably in an acute care, skilled or… more
- YesCare Corp (Brentwood, TN)
- …contract specific time frame to ensure resources are maximized. + Work with other UM inpatient and outpatient nurse reviewers to assure proper treatment in the ... a pioneer in correctional healthcare services, YesCare is committed to innovation, clinical expertise, and compassionate care. By choosing a career with YesCare, you… more
- Humana (Nashville, TN)
- …us put health first** Full-Time, Remote Telephonic opportunity The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, ... medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are varied and frequently require interpretation… more
- Humana (Nashville, TN)
- …a part of our caring community and help us put health first** The Telephonic Nurse Case Manager will be a member of the In-Home Case Management Team, providing a ... beneficiary's capacity for self- care, to cost-effectively achieve desired clinical outcomes and to enhance quality of medical care....and to enhance quality of medical care. The **Telephonic Nurse Case Manager** will collect and document data to… more
- Vanderbilt University Medical Center (Nashville, TN)
- …through preeminent programs in patient care, education, and research. **Organization:** TMO/ UM Team E **Job Summary:** JOB SUMMARY Collaborates with the health ... key Pillar outcomes and system improvement goals including financial, satisfaction, and clinical as the nursing component of the care coordination model. Assists in… more
- Highmark Health (Nashville, TN)
- …experience, or provider operations and/or health insurance experience + 1 year in a clinical setting **Preferred** + 5 years in UM /CM/QA/Managed Care + 1 year ... over a specified panel of members that range in health status/severity and clinical needs; and assesses health management needs of the assigned member panel and… more
- Vanderbilt University Medical Center (Nashville, TN)
- …continued stay, for inpatients and outpatients in house beds; denial management; DRG/ Clinical documentation program; tracking of avoidable day data; support of JCAHO ... Physicians; Clinics; Patient Care Center administrators; Informatics Technology. Collaborate with UM Physician Advisor. + Adjust work schedules or project priorities… more
- Datavant (Nashville, TN)
- …recognized medical necessity criteria and standards of care, along with clinical knowledge and expertise successfully. Ideal candidate should be a Licensed ... Practical Nurse or Registered Nurse well versed in...denials and appeal writing for inpatient admission. Experience with clinical criteria resources and payor guidelines. **You will:** +… more