- Humana (Nashville, TN)
- …of our caring community and help us put health first** The Staff Utilization Management Pharmacist is a clinical expert responsible for conducting ... holiday per calendar year** **Job Description:** The Staff Utilization Management Pharmacist is a clinical professional responsible for conducting… more
- Community Health Systems (Franklin, TN)
- …Documents all utilization review activities in the hospital's case management software, including clinical reviews, escalations, avoidable days, payer ... . + Serves as a key contact for facility staff and insurance representatives regarding utilization review...+ 2-4 years of clinical experience in utilization review, case management , or acute care… more
- Humana (Nashville, TN)
- …part of our caring community and help us put health first** The Utilization Management Behavioral Health Professional 2 utilizes behavioral health knowledge and ... and communication of medical services and/or benefit administration determinations. The Utilization Management Behavioral Health Professional 2 work assignments… more
- Covenant Health Inc. (Knoxville, TN)
- …in utilization management . + Provides monitoring and oversight of non- clinical utilization staff activities. + Provides advice and counsel to ... Overview Registered Nurse Utilization Management PRN/OCC,Hours Vary, Day Shifts...non- clinical precertification staff . + Assists with delayed claims review to determine… more
- Community Health Systems (Franklin, TN)
- …The manager supports and coordinates the various aspects of the hospital's utilization management program, denials and appeals activities. Works with UR ... professional clinical expertise to ensure quality, timely, and cost effective utilization management to achieve optimal outcomes. The manager will be… more
- Veterans Affairs, Veterans Health Administration (Smyrna, TN)
- … denials. Provides feedback as appropriate, for performance improvement, utilization management , and compliance related issues. Conducts precertification ... Revenue, Billing, Insurance Verification, Veteran Services, Compliance, Providers, Health Information Management (HIM), Utilization Management (UM), and… more
- Community Health Systems (Franklin, TN)
- …and reduce potential denials, utilizing input from the Utilization Review Clinical Specialist. + Monitors and updates case management software with ... preferred **Knowledge, Skills and Abilities** + Strong knowledge of utilization management principles, payer requirements, and healthcare regulations.… more
- HCA Healthcare (Nashville, TN)
- …and supply chain operations. ii) Value Analysis iii) Clinical Resource Management Program iv) Product standardization and utilization + Interacts and ... Do you want to join an organization that invests in you as a PRN Director Clinical Resource Management ? At HealthTrust, a division of HCA, you come first. HCA… more
- HCA Healthcare (Nashville, TN)
- … and supply chain operations. 2. Value Analysis and Clinical Resource Management Program 3. Product standardization and utilization 4. Produce and provide ... reviewing and optimizing the current GPO contract portfolio, developing comprehensive clinical and utilization protocols, and developing and executing product… more
- Highmark Health (Nashville, TN)
- …and financial stakeholders **Preferred** + Experience with medical policy and utilization management functions + Medical coding experience **LICENSES or ... Utilize robust, data-driven insights from complex healthcare datasets (eg, claims, clinical , utilization , pharmaceutical) to inform policy development, identify… more
- HCA Healthcare (Hermitage, TN)
- …Supervise staff and assist with employee evaluation process. + Coordinate case management staff participation on committees which relate to PI and patient ... colleagues invested over 156,000 hours impacting our communities. As a Manager of Clinical Resource Management with TriStar Summit Medical Center, you can be… more
- Deloitte (Nashville, TN)
- …plans for both formal and informal education of physicians, CDI team, health information management and other clinical staff + Develop in-service education ... clinical registered nurse, physician, physician assistant, case manager, clinical documentation specialist, utilization review, informatics RN, Quality, DRG… more
- Fresenius Medical Center (Greeneville, TN)
- …courses and that licensures/certifications are current. + Provides support for all clinical staff members at regular intervals and encourages professional ... eligibility for treatment. + Reports changes in patient status regarding any clinical , insurance, or travel and transportation issues. STAFF : + Participates… more
- HCA Healthcare (Brentwood, TN)
- …and activities that promote professional competency for nursing, inter-professional and non-licensed clinical staff in assigned hospitals **What you will do in ... labor management , including position control, scheduling excellence, productivity management , and premium pay utilization . Maintains staffing to ensure… more
- Vanderbilt University Medical Center (Nashville, TN)
- …educational programs that advance the professional development, knowledge and effectiveness of staff and clinical pharmacists. + The responsibilities listed are ... the lead role in developing best practices in medication management . Has the ability to determine the clinical... management . Has the ability to determine the clinical appropriateness of each medication taken by the patient,… more
- Veterans Affairs, Veterans Health Administration (Memphis, TN)
- …of the EDRP application. Responsibilities VA Careers - Licensed Clinical Social Worker: https://youtube.com/embed/U\_xC25QsN0w Total Rewards of a Allied Health ... mental health setting and can make complex and independent clinical judgement, as demonstrated by at least two years...times in the VHA Emergency Departments that have higher utilization , higher risk patients, specialized intensive care units, and… more
- CVS Health (Nashville, TN)
- …each and every day. The supervisor is responsible for oversight of healthcare management staff including the organization and development of high performing ... teams. Works closely with functional area management to ensure consistency in clinical interventions...experience as a Registered Nurse - 1+ years of Utilization Management experience - Must have experience… more
- Vanderbilt University Medical Center (Nashville, TN)
- …educational programs that advance the professional development, knowledge and effectiveness of staff and clinical pharmacists. + The responsibilities listed are ... plan to meet the individualized drug therapy needs of the patient. The clinical specialist is responsible for leading efforts in the prevention and reporting of… more
- Evolent (Nashville, TN)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. Tasks ... independent nursing judgement and decision-making, physician-developed medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse… more
- Prime Therapeutics (Nashville, TN)
- …and timely fashion. + Demonstrates the value of pharmacy solutions (unit cost, utilization management & patient care enhancement). + Identifies opportunities for ... visa or residency sponsorship **Additional Qualifications** + 3-5 years' experience in clinical operations, quality, network, pharmacy or project management OR a… more