- Community Health Systems (Franklin, TN)
- **Job Summary** The Clinical Utilization Review Specialist is responsible for evaluating the necessity, appropriateness, and efficiency of hospital ... collaborates with healthcare providers to facilitate efficient patient care. The Clinical Utilization Review Specialist monitors adherence to hospital… more
- Canon USA & Affiliates (Nashville, TN)
- **XR Regional Clinical Sales Support Specialist - req1516** **OVERVIEW** The Clinical Sales Support Specialist (CSSS) role will report into the XR BU and ... keep the clinical /sales touch current. + Provide clinical advice to improve utilization of the...as booth staffing, virtually and/or in person, as demo specialist and subject matter experts for sales support, as… more
- Healthfirst (TN)
- …clinical practice with experience in appeals & grievances, claims processing, utilization review or utilization management/case management. + Demonstrated ... Responsibilities:** + Responsible for case development and resolution of clinical cases, such as: Pre-existing Conditions, Prior Approval, Medical...understanding of Utilization Review Guidelines (NYS ART 44 and 49 PHL), InterQual,… more
- Houston Methodist (TN)
- …caring for adults in an acute care hospital setting + Coding and utilization review experience preferred **LICENSES AND CERTIFICATIONS - REQUIRED** + RN ... At Houston Methodist, the Clinical Documentation Specialist is responsible for improving the overall quality and completeness of clinical documentation. This… more
- Canon USA & Affiliates (Nashville, TN)
- **Clinincal IDN Luminary Specialist - req1499** **OVERVIEW** The Clinical IDN/Luminary Specialist (CILS) role will report into the National Strategic ... IDN Manager, UL Clinical Applications Manager, UL Clinical Sales Specialist and clinical ...a liaison between the customer and CMSU. + Provide clinical advice to customers to improve utilization … more
- HCA Healthcare (Nashville, TN)
- …face or telemedicine assessment completed and physician consult. + Provides a thorough clinical review and risk assessment with appropriate level of care ... treatment is reimbursed by contacting managed care organizations and completing initial utilization review . Documents in Midas as required. Involves mobile… more
- HCA Healthcare (Nashville, TN)
- …to clinicians regarding deficiencies or OASIS corrections (with feedback from Quality Review Specialist ) to ensure the medical records reflect compliance with ... **Description** **Introduction** We are seeking a Home Health RN Clinical Manager with TriStar Healthcare at Home to promote growth and unlock possibilities. At HCA… more
- Evolent (Nashville, TN)
- …when available, within the regulatory timeframe of the request. + Utilizes medical/ clinical review guidelines and parameters to assure consistency in the ... make a meaningful impact on patient care in a non- clinical setting? Join our Utilization Management team... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more
- Evolent (Nashville, TN)
- …(FDA), and various prior authorization lists, facilitating timely decision-making for clinical and business review teams. + Demonstrate strong analytical ... Minimum 3 years of professional experience in value-based healthcare analytics or utilization management within a payer, provider, clinical vendor, managed care,… more
- Covenant Health Inc. (Lenoir City, TN)
- …identified needs. + Facilitates timely documentation review with the Clinical Documentation Improvement (CDI) specialist , as necessary to ensure appropriate ... Summary: The RN Care Manager II is responsible for integrating evidenced based clinical practice into the patient care setting, coordinating education of staff and… more