- CVS Health (Nashville, TN)
- …And we do it all with heart, each and every day. **Position Summary:** The ** Utilization Management Clinical Nurse Consultant - Prior Authorization** ... internal and external constituents in the coordination and administration of the utilization /benefit management function. + Gathers clinical information and… more
- Humana (Nashville, TN)
- …help us put health first** Full-Time, Remote Telephonic opportunity The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- Cognizant (Nashville, TN)
- …. Educational background - Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management experience with managed health care plan ... Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced...care revenue cycle or clinic operations . Experience in utilization management to include Clinical … more
- Humana (Nashville, TN)
- …of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, ... determination of the appropriate courses of action. The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and independent… more
- CVS Health (Nashville, TN)
- …Must have active current and unrestricted RN licensure in state of residence - Utilization Management is a 24/7 operation and work schedules will include ... in med surg or specialty area - Managed Care experience preferred, especially Utilization Management - Preference for those residing in EST zones **Education**… more
- CVS Health (Nashville, TN)
- … solutions that promote high-quality healthcare for members. We are seeking a dedicated Utilization Management (UM) Nurse Consultant to join our remote team. ... listening, and use of a computer. + Flexibility to provide coverage for other Utilization Management (UM) Nurses across various UM specialty teams as needed,… more
- CVS Health (Nashville, TN)
- …internal and external constituents in the coordination and administration of the utilization /benefit management function. + Gathers clinical information and ... skills to coordinate, document, and communicate all aspects of the utilization /benefit management program. + Applies critical thinking and knowledge in… 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 ... + 2-4 years of clinical experience in utilization review, case management , or acute care...confidentiality standards. **Licenses and Certifications** + RN - Registered Nurse - State Licensure and/or Compact State Licensure required… more
- Centene Corporation (Nashville, TN)
- …Nurse (RN) or licensed clinician only. 2-4 years of behavioral health utilization management experience.** **Must have a current state's license.** **Position ... changes everything for our 28 million members as a clinical professional on our Medical Management /Health Services...Analyzes BH member data to improve quality and appropriate utilization of services + Provides education to providers members… more
- Sedgwick (Knoxville, TN)
- …staff and claims examiners regarding treatment issues. + Performs treatment utilization management reviews. + Maintains client's privacy and confidentiality; ... your RN clinical knowledge and experience to assist in the management of complex medical conditions, treatment planning and recovery from illness or injury.… more
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