- 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
- Evolent (Nashville, TN)
- …coordinating with UM staff to ensure timely and accurate communication of clinical decisions. + Responsible for completion of UM projects and participation ... the mission. Stay for the culture. **What You'll Be Doing:** The Nurse Practitioner/Physician Assistant (ARNP/NP/PA) Vascular Surgey is responsible for support and… 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. ... policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member...medical management activities in a managed care environment + UM /UR experience + Clinical experience in Oncology,… 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 and functions ... applicant count is reached will be accepted and considered.** Responsibilities of the RUR nurse include, but are not limited, to the following: Serves as a patient… 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
- Covenant Health Inc. (Sevierville, TN)
- Overview Registered Nurse , Critical Care PRN/OCC, Variable Hours, Day Shift LeConte Medical Center Overview: LeConte Medical Center is a part of Covenant Health, our ... wing and 8 bed IMC (step-down) wing. With small nurse to patient ratios, our staff is able to...+ Recommends interventions. + Evaluates plan of care. + Clinical expertise and knowledge is such that individual can… 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 ... panel of members that range in health status/severity and clinical needs; and assesses health management needs of the...RN licensure OR Current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC) or WV or DE or… more
- Vanderbilt University Medical Center (Nashville, TN)
- …through preeminent programs in patient care, education, and research. **Organization:** TMO/ UM Team D **Job Summary:** Collaborates with the health care team ... key Pillar outcomes and system improvement goals including financial, satisfaction, and clinical as the nursing component of the care coordination model. Assists in… more
- BlueCross BlueShield of Tennessee (Chattanooga, TN)
- …UM pre\-certifications and appeals, utilizing medical appropriateness criteria, clinical judgement, and contractual eligibility\. + Various immunizations and/or ... Health and Withdrawal Management\. + Present cases confidently and effectively during clinical rounds\. + Work independently with minimal supervision\. + Excel in a… 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 healthcare ... utilization management processes and coordinates communication between members of the UM team to ensure timely follow through for status placement. Collaborates… more