• Utilization Management Nurse

    Humana (Nashville, TN)
    …community and help us put health first** Full-Time, Remote Telephonic opportunity The Utilization Management Nurse 2 utilizes clinical nursing skills to ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
    Humana (09/12/25)
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  • Utilization Management Nurse

    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 ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
    Humana (11/05/25)
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  • Utilization Management Nurse

    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 (11/04/25)
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  • SNF Utilization Management RN…

    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 ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
    Humana (09/12/25)
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  • Revenue Utilization Review (RUR) Assistant…

    Veterans Affairs, Veterans Health Administration (Smyrna, TN)
    …authority eligibility requirements, first- and third-party medical review criteria, nurse utilization review processes, clinical documentation requirements, ... of functions, and the integration of VHA and industry best standards. The Revenue Utilization Review (RUR) Assistant Nurse Manager is accountable to the CPAC… more
    Veterans Affairs, Veterans Health Administration (11/04/25)
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  • RN Utilization Specialist/Review…

    YesCare Corp (Brentwood, TN)
    …as indicated. + Communicate and guide staff and physicians regarding utilization management program development, implementation, and evaluation and ... lives through care and expertise. **Key Responsibilities:** + The nurse will focus on what's best for the patients...license + No less than 5 years' experience in utilization management , case management , quality… more
    YesCare Corp (10/30/25)
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  • Utilization Management Clinical…

    CVS Health (Nashville, TN)
    …clinical skills to coordinate, document, and communicate all aspects of the utilization /benefit management program. + Applies critical thinking and knowledge in ... and external constituents in the coordination and administration of the utilization /benefit management function. + Gathers clinical information and applies… more
    CVS Health (10/26/25)
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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 ... admissions and extended stays, identifying opportunities for process improvements to enhance utilization management . + Serves as a key contact for facility… more
    Community Health Systems (10/14/25)
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  • Utilization Management Clinician-…

    CVS Health (Nashville, TN)
    …clinical skills to coordinate, document and communicate all aspects of the utilization /benefit management program. Applies critical thinking and is knowledgeable ... and external constituents in the coordination and administration of the utilization /benefit management function. **Required Qualifications** + 3+ years post… more
    CVS Health (11/01/25)
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  • RN- Utilization Review

    Ascension Health (Nashville, TN)
    …and coordinate compliance to federally mandated and third party payer utilization management rules and regulations. **Requirements** Licensure / Certification ... offer._ **Responsibilities** Provide health care services regarding admissions, case management , discharge planning and utilization review. +.../ Registration: + Licensed Registered Nurse credentialed from the Tennessee Board of Nursing or… more
    Ascension Health (11/05/25)
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