- HCA Healthcare (Nashville, TN)
- …**Introduction** Do you want to join an organization that invests in you as a Utilization Review Services Registered Nurse? At Parallon, you come ... 3% to 9% of pay (based on years of service ) + Employee Stock Purchase Plan with 10% off...make a difference. We are looking for a dedicated Utilization Review Services Registered… more
- Ascension Health (Nashville, TN)
- …and salary range at the time of the offer._ **Responsibilities** Direct services , workflow and resources for assigned nursing travelers. + Develop departmental goals ... + Direct clinical activities, including patient assessment, care plan development, service level determination, patient visits, and complaint management. + Prepare… more
- Vanderbilt University Medical Center (Nashville, TN)
- …that the appropriate admission status is ordered. Conducts initial admission based on utilization review medical necessity criteria. Refers cases for secondary ... difficulty. * Clinical Applications Systems (Novice): Possesses fundamental proficiency in utilization review systems, clinical support systems and business… more
- Sharecare (Nashville, TN)
- …appropriate total healthcare management and ensure cost effective, appropriate resource utilization and quality outcomes. The Clinical Registered Nurse is ... stratification level. + Identifies participant barriers to accessing health care services . Coordinates with Provider Service Managers and/or other members… more
- Vanderbilt University Medical Center (Nashville, TN)
- …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 ... floating within the Hi-RiSE TVC Clinic and floating to the VPEC OHO Clinic * Comfortable with the clinical review of testing results and visit plans to determine… 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 ... standards of conduct and clinical code of ethics and practice. . Implementing in- services and training. . Maintaining a current body of knowledge in areas of… more
- Sharecare (Nashville, TN)
- …of the care enhancement program by providing telephonic care and resource utilization for members in an appropriate, efficient, and cost-effective manner while ... orientation and to take the pre and post-test to review competency during orientation. Yearly competency test is required...Functions:** + Achievement of Clinical Objectives: + Deliver dietary services within the RD scope of practice to members… 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 ... transplants; the ideal candidate will have experience either in utilization review or case management for transplants....on the severity of illness and the site of service . **KNOWLEDGE/SKILLS/ABILITIES** + Assesses services for members… more
- Molina Healthcare (Bowling Green, KY)
- …reliable transportation. **Preferred Experience** Previous experience in ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of ... and cost-effective based on the severity of illness and the site of service . **KNOWLEDGE/SKILLS/ABILITIES** + Assesses inpatient services for members to ensure… more
- Molina Healthcare (Bowling Green, KY)
- …health plan's Healthcare Services (clinical operations) teams including Utilization Management (prior-authorization, inpatient review ) and Care Management ... cost-effective based on the severity of illness and the site of service . **KNOWLEDGE/SKILLS/ABILITIES** The VP, Healthcare Services is responsible for oversight… more
- Evolent (Nashville, TN)
- …+ Reviews charts and analyzes clinical record documentation in order to approve services that meet clinical review criteria. + Conducts ongoing activities which ... Nurse, you will be a key member of the utilization management team. We can offer you a meaningful...Inspector General of the Department of Health and Human Services or the General Service Administration (GSA),… 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 ... Chief Medical Officer on denial decisions. + Resolves escalated complaints regarding Utilization Management and Long-Term Services & Supports issues. +… more
- HCA Healthcare (Nashville, TN)
- …assessments of focused topics within HCA Healthcare hospitals/ASCs including credentialing, utilization management, peer review , medical staff and board bylaws, ... include: + Comprehensive medical coverage that covers many common services at no cost or for a low copay....3% to 9% of pay (based on years of service ) + Employee Stock Purchase Plan with 10% off… more
- HCA Healthcare (Nashville, TN)
- …plans and programs include: + Comprehensive medical coverage that covers many common services at no cost or for a low copay. Plans include prescription drug ... and behavioral health coverage as well as free telemedicine services and free AirMed medical transportation. + Additional options...3% to 9% of pay (based on years of service ) + Employee Stock Purchase Plan with 10% off… more
- Molina Healthcare (Bowling Green, KY)
- …abuse through the identification of aberrant coding and/or billing patterns through utilization review . * Incorporate leadership and communication skills to work ... and abuse. Duties include performing accurate and reliable medical review audits that may also include coding and billing...clinical knowledge to assess the medical necessity, level of services , and/or appropriateness of care in cases. The SIU… more
- Elevance Health (Nashville, TN)
- …must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US ... member of the Elevance Health family of companies providing unparalleled level of service in pharmacy benefits. By leveraging the power of new technologies, our… more
- HCA Healthcare (Nashville, TN)
- …plans and programs include: + Comprehensive medical coverage that covers many common services at no cost or for a low copay. Plans include prescription drug ... and behavioral health coverage as well as free telemedicine services and free AirMed medical transportation. + Additional options...3% to 9% of pay (based on years of service ) + Employee Stock Purchase Plan with 10% off… more
- HCA Healthcare (Nashville, TN)
- …from Home which is part of the nation's leading provider of healthcare services , Methodist Healthcare. **Benefits** Work from Home, offers a total rewards package ... include: + Comprehensive medical coverage that covers many common services at no cost or for a low copay....3% to 9% of pay (based on years of service ) + Employee Stock Purchase Plan + Retirement readiness… more
- HCA Healthcare (Bowling Green, KY)
- …plans and programs include: + Comprehensive medical coverage that covers many common services at no cost or for a low copay. Plans include prescription drug ... and behavioral health coverage as well as free telemedicine services and free AirMed medical transportation. + Additional options...3% to 9% of pay (based on years of service ) + Employee Stock Purchase Plan with 10% off… more
- Lincoln Financial (Nashville, TN)
- …Coronary Care, , Trauma , Disability, Workman's comp or case management or Utilization review **Application Deadline** **What's it like to work here?** At ... Rehabilitation Coordinators (VRC) and others to support with return-to-work services * Effectively manages assigned caseload within department productivity goals… more