- BlueCross BlueShield of Tennessee (Chattanooga, TN)
- …individuals facing mental health challenges, while working behind the scenes? If so, ** Utilization Management** might be the perfect fit for you\! In this role, ... Excel in a **fast\-paced, dynamic environment** \. **Our Ideal Candidates will have an RN or Social Work license and:** + **3 years** \- Clinical behavioral health /… more
- Community Health Systems (Franklin, TN)
- **Job Summary** The Manager of Utilization Review oversees a team of utilization review nurses and coordinators, ensuring compliance with clinical ... regulatory standards, and enhancing the overall utilization review process to optimize patient care...+ 3-5 years work experience in healthcare as a nurse required + 1-3 years work experience in Care… more
- Community Health Systems (Franklin, TN)
- …Knowledge of HIPAA regulations and patient confidentiality standards. **Licenses and Certifications** + RN - Registered Nurse - State Licensure and/or ... **Job Summary** The Clinical Utilization Review Specialist is responsible for evaluating the necessity, appropriateness, and efficiency of hospital services to… more
- Veterans Affairs, Veterans Health Administration (Smyrna, TN)
- …of VHA and industry best standards. The Revenue Utilization review (RUR) Registered Nurse ( RN ) is an active member of the revenue cycle program ... level degree in Nursing may have opportunity to become registered as a nurse with a state...nursing experience. 1-3 years of relevant case management or utilization review experience. Ability to collaborate effectively… more
- Covenant Health Inc. (Knoxville, TN)
- Overview Registered Nurse Utilization Management PRN/OCC,Hours Vary, Day Shifts Covenant Health Overview: Covenant Health is the region's top-performing ... payors as applicable. + Completes daily work lists for utilization review meeting the time frames set...case management experience. Licensure Requirement: Current licensure as a Registered Nurse ( RN ) as issued… more
- Humana (Nashville, TN)
- …an impact** **Use your skills to make an impact** **Required Qualifications** + **Licensed Registered Nurse ( RN )** in the (appropriate state) with no ... caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing...in an acute care setting + Previous experience in utilization management/ utilization review for a… more
- CVS Health (Nashville, TN)
- …+ Perform medical necessity reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse with at least 1 year of experience in a hospital ... setting. + A Registered Nurse that holds an active, unrestricted...lower levels of care. + 1+ years' experience in Utilization Review . + CCM and/or other URAC… more
- Vanderbilt University Medical Center (Nashville, TN)
- …continuum of care. Conducts initial and/or concurrent utilization review medical necessity criteria. ... instead of emphasizing negative elements. **Position Qualifications:** **Responsibilities:** **Certifications:** LIC- Registered Nurse - Licensure-Others **Work Experience:** Relevant… more
- Quality Center for Rehabilitation and Healing (Lebanon, TN)
- …meaningful contributions to the rehab team conferences, patient care conferences, utilization review meetings, family conferences, and caregiver training ... . 5 days a week 37.5 - 40 hours per week Respiratory Nurse ( RN ) We are searching for a highly motivated, flexible, organized, skilled respiratory therapist… more
- Fresenius Medical Center (Greeneville, TN)
- …auditing activities. + Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. + Manages clinic ... financials including efficient utilization of supplies or equipment and regular profits and...of supplies or equipment and regular profits and loss review . + Responsible for all required network reporting and… more
- Veterans Affairs, Veterans Health Administration (Murfreesboro, TN)
- … Nurse -Community Living Center 8B. The Community Living Center (CLC) Registered Nurse ( RN ) executes position responsibilities that include: Demonstrate ... the VHA Education Loan Repayment Services program office after review of the EDRP application. Former EDRP participants ineligible...level degree in Nursing may have opportunity to become registered as a nurse with a state… more
- Wellpath (Franklin, TN)
- …or Care Management Certification + RN preferred EXPERIENCE + Previous utilization review and/or case management and pre-certification experience + Knowledge ... make a difference** The Regional Care Manager (RCM) is responsible for utilization review , care coordination, and daily care management across multiple sites and… 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 ... nurses play a vital part. We know that every nurse 's path and purpose is unique. Do you want...patients in regard to managed care organizations + Conducts utilization review for managed care cases in… more
- Elevance Health (Nashville, TN)
- …on relatively complex case types that do not require the training or skill of a registered nurse . Acts as a resource for more junior Clinicians. **How You Will ... a minimum of 6 years of clinical experience and/or utilization review experience. + Current active, valid...experience. + Current active, valid and unrestricted LPN/LVN or RN license and/or certification to practice as a health… more
- STG International (Savannah, TN)
- …in the management/coordination of the clinic's day-to-day activity, in conjunction with the Registered Nurse ( RN )/CBOC Manager and VA Program's philosophy. + ... safety. + Participate in quality improvement, care management, risk management, peer review , utilization review , clinical outcomes, and health enhancement… more
- Deloitte (Nashville, TN)
- …Bachelor's degree in nursing, medical degree, or physician assistant required + Current Registered Nurse ( RN ) license required + Certified Clinical ... nurse , physician, physician assistant, case manager, clinical documentation specialist, utilization review , informatics RN , Quality, DRG Validation and… more
- Green Hills Center for Rehabilitation and Healing (Nashville, TN)
- …trends on a monthly basis + Responsible for timely and accurate completion of Utilization Review and Triple Check + Serves on, participates in, and attends ... are seeking qualified candidates who have experience as an RN or LPN and are committed to help our...as directed by their supervisor and Administrator Qualifications: + Registered Nurse with current, active license in… more
- Covenant Health Inc. (Knoxville, TN)
- Overview Registered Nurse Care Manager, Continuum of Care Full Time, 80 Hours Per Pay Period , Day Shift M-F. May rotate weekend and minor holidays. Parkwest ... of Care Department is staffed by a Manager, Coordinator, RN Care Managers, and Masters Level Social Workers. They...management services within the scope of practice as a registered nurse meeting all required standards both… more
- Covenant Health Inc. (Sevierville, TN)
- Overview Registered Nurse Care Manager, Continuum of Care PRN, Variable Hours & Shift LeConte Medical Center Overview: LeConte Medical Center is a part of ... + Provides care management services within the scope of practice as a registered nurse meeting all required standards both legal and regulatory. Education:… more
- Covenant Health Inc. (Harriman, TN)
- …duties + Provides care management services within the scope of practice as a registered nurse meeting all required standards both legal and regulatory + In ... Overview RN Care Manager, Continuum of Care PRN/OCC, Variable...that will meet identified needs. + Facilitates timely documentation review with the Clinical Documentation Improvement (CDI) specialist, as… more
