- Humana (Nashville, TN)
- …help us put health first** Humana Healthy Horizons in Kentucky is seeking a Utilization Management Behavioral Health Professional 2 who utilizes ... and communication of medical services and/or benefit administration determinations. The Utilization Management Behavioral Health Professional… more
- Lincoln Financial (Nashville, TN)
- …including 1 year in claims, disability management (STD/LTD), worker's compensation, utilization review, and or behavioral health case management ... **The Role at a Glance** We are excited to bring on a knowledgeable and motivated Behavioral Health Consultant to our Clinical Organization. As a Behavioral … more
- HCA Healthcare (Nashville, TN)
- **Description** **Introduction** Do you have the career opportunities as a Behavioral Health Utilization Review Specialist you want with your current ... of colleagues. Do you want to work as a Behavioral Health Utilization Review Specialist... experience required + 1- 3 years relevant case management / utilization review experience preferred +… more
- Evolent (Nashville, TN)
- …the mission. Stay for the culture. **What You'll Be Doing:** The **Coordinator, Intake Utilization Management ** at Evolent will serve as a point of contact for ... and client contractual agreements. **Collaboration Opportunities** : The Coordinator, Intake Utilization Management reports directly to the Manager, … more
- Highmark Health (Nashville, TN)
- …of clinical, case/ utilization management and/or disease/condition management experience, or provider operations and/or health insurance experience ... health status/severity and clinical needs; and assesses health management needs of the assigned member...clinical care is being provided. **Preferred** + Certification in utilization management or a related field +… more
- Highmark Health (Nashville, TN)
- …timeframes and notification requirements are met + Communicate effectively with Utilization Management Staff, providers, other internal and external customers ... processing of pre-certification requests for authorization of medically necessary health care services at the appropriate level of care,...and management + Route Cases Based on Established Guidelines +… more
- Elevance Health (Knoxville, TN)
- …member's circle of support and overall management of the individuals physical health (PH)/ behavioral health (BH)/LTSS needs, as required by applicable ... associates, and may be involved in process improvement initiatives. + Submits utilization /authorization requests to utilization management with documentation… more
- Highmark Health (Nashville, TN)
- …(Claims, Dental Benefits, Customer Service, Membership & Billing), Provider Data Management , Underwriting, and Professional Relations. **This role will support the ... including gathering data from multiple sources related to Benefit/Claim Utilization , Enrollment, Networks ( utilization , disruption, geo-access) and making… more
- HCA Healthcare (Nashville, TN)
- …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 ... in a new era as a Regional Director Workforce Health Safety where building a healthier tomorrow is more...effective labor management , including position control, productivity management , and premium pay utilization . Maintains staffing… more
- Elevance Health (TN)
- …identification, evaluation, coordination and management of member's needs, including physical health , behavioral health , social services and long term ... chronic illnesses, co-morbidities, and/or disabilities, to insure cost effective and efficient utilization of health benefits. + Obtains a thorough and accurate… more
- Elevance Health (Nashville, TN)
- …A proud member of the Elevance Health family of companies, Carelon Behavioral Health , formerly Beacon Health Options, offers superior clinical mental ... preferred. + Extensive orthopedic surgery experience preferred. + Experience with utilization management , especially with CMS guidelines preferred. For… more
- Highmark Health (Nashville, TN)
- …:** **JOB SUMMARY** This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and ... (DO) **Substitutions** + None **Preferred** + Master's Degree in Business Administration/ Management or Public Health **EXPERIENCE** **Required** + 5 years… more
- The Cigna Group (Chattanooga, TN)
- …to lead this function. The COO will have oversight across the Pharmacy Benefits Management , Evicore, and Utilization Management , and will work closely with ... Lead Strategy Officer for Express Scripts & Evernorth Care Management will support and report directly to the Express...-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k)… more
- HCA Healthcare (Nashville, TN)
- …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 ... want to join an organization that invests in you as a Director Equipment Management Operations? At HealthTrust, you come first. HCA Healthcare has committed up to… more
- HCA Healthcare (Nashville, TN)
- …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 Air Med ... Do you have the career opportunities as a Case Management RN you want in your current role? We...Center, offers a total rewards package that supports the health , life, career and retirement of our colleagues. The… more
- Covenant Health Inc. (Alcoa, TN)
- …Parkwest Medical Center. Assures that productivity targets are met. + Coordinates the utilization management plan for physicians and nurse practitioners with the ... Minimum Experience Two (2) years supervisory experience required. Experience in behavioral health setting preferred. Licensure Requirement Must have current… more
- Elevance Health (Nashville, TN)
- …evaluation, coordination and management of members needs, including physical health , behavioral health , social services and community services ... the health care team, to ensure cost effective and efficient utilization of health benefits. + Decision making skills will be based upon the current needs… more
- Highmark Health (Nashville, TN)
- …with strong analytical and communication skills. **ESSENTIAL RESPONSIBILITIES** + Perform management responsibilities to include, but are not limited to: involved in ... termination decisions, coaching and development, rewards and recognition, performance management and staff productivity.Plan, organize, staff, direct and control the… more
- Highmark Health (Nashville, TN)
- …portfolio of AI-powered products, including a core administrative platform, modular utilization and care management solutions, patient-focused digital products, ... Marketing qualified leads and sales qualified leads. + Opportunity Pipeline Management : Manage and forecast the sales pipeline, providing accurate revenue… more
- Highmark Health (Nashville, TN)
- **Company :** Highmark Health **Job Description :** **JOB SUMMARY** This job is a strong advocate of cloud technology and engineering support necessary to drive the ... to senior or lead engineers to further cloud service utilization and optimization. + Develops automation scripts and other...of action. + Level 2 Incident, problem and change management as it pertains to the responsibilities of the… more