• Utilization Management…

    Humana (Nashville, TN)
    **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...action. Humana is seeking a Part C Grievance & Appeals (G&A) Nurse who will assist in… more
    Humana (01/18/26)
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  • Appeals Nurse

    Evolent (Nashville, TN)
    …and accomplishments. **What You Will Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to ... and as an RN - **Required** + Minimum of 5 years in Utilization Management , health care Appeals , compliance and/or grievances/complaints in a quality… more
    Evolent (12/24/25)
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  • Clinical Utilization Review Specialist

    Community Health Systems (Franklin, TN)
    …appropriateness, and efficiency of hospital services to ensure compliance with utilization management policies. This role conducts admission and continued ... stay reviews, supports denials and appeals activities, and collaborates with healthcare providers to facilitate...extended stays, identifying opportunities for process improvements to enhance utilization management . + Serves as a key… more
    Community Health Systems (01/13/26)
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  • Manager Utilization Review

    Community Health Systems (Franklin, TN)
    …effectively. The manager supports and coordinates the various aspects of the hospital's utilization management program, denials and appeals activities. Works ... clinical expertise to ensure quality, timely, and cost effective utilization management to achieve optimal outcomes. The...+ 3-5 years work experience in healthcare as a nurse required + 1-3 years work experience in Care… more
    Community Health Systems (01/14/26)
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  • Infusion Referral Nurse Sr- REMOTE

    Prime Therapeutics (Nashville, TN)
    …of post-degree clinical experience. + Experience in managed care, specialty drugs, care management and utilization review. + Meets Credentialing criteria. + At ... the future of pharmacy with us. **Job Posting Title** Infusion Referral Nurse Sr- REMOTE **Job Description** Under supervision, is responsible for performing… more
    Prime Therapeutics (01/16/26)
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  • Behavioral Health Clinical Review Manager

    BlueCross BlueShield of Tennessee (Chattanooga, TN)
    …of individuals facing mental health challenges, while working behind the scenes? If so, ** Utilization Management ** might be the perfect fit for you\! In this ... Health settings** \(both inpatient and outpatient\)\. + Prior experience in ** Utilization Management ** or **Managed Care** \. + Strong **communication… more
    BlueCross BlueShield of Tennessee (01/15/26)
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