• Utilization Management Nurse

    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 ... clinical skills to coordinate, document and communicate all aspects of the utilization /benefit management program. + Applies critical thinking and knowledge in… more
    CVS Health (07/23/25)
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  • Utilization Management Nurse

    CenterWell (Nashville, TN)
    …+ Prior clinical experience, managed care experience, DME, Florida Medicaid **OR** utilization management experience + Demonstrates Emotional Maturity + Ability ... Orthopedic procedures + Compact License preferred + Previous experience in utilization management within Insurance industry + Previous Medicare… more
    CenterWell (08/02/25)
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  • Clinical UM Nurse 2

    CenterWell (Nashville, TN)
    **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and ... high-volume community or mail order pharmacy practice environment + Previous experience in utilization management + Education: BSN or Bachelor's degree in a… more
    CenterWell (08/01/25)
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  • Utilization Review Services RN

    HCA Healthcare (Nashville, TN)
    …of nursing experience required + 1 - 4 years of relevant case management / utilization review experience preferred + Registered Nurse - Currently licensed as a ... **Introduction** Do you have the career opportunities as a Utilization Review Services RN you want with your current...of colleagues. Do you want to work as a Utilization Review Services RN where your passion for creating… more
    HCA Healthcare (08/03/25)
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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 (07/31/25)
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  • RN- Utilization Review

    Baptist Memorial (Memphis, TN)
    Overview Purpose of Position and Scope of Responsibility Job Summary The Utilization Review Nurse is responsible for evaluating the medical necessity and ... appropriateness of healthcare services and treatment as prescribed by utilization review standards. The UR Nurse works with providers, insurance companies and… more
    Baptist Memorial (06/14/25)
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  • Disease Management Nurse - Remote

    Sharecare (Nashville, TN)
    …appropriate resource utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during their interactions with participants ... for everyone. To learn more, visit www.sharecare.com . **Job Summary:** The Disease Management Nurse has the responsibility for supporting the goals and… more
    Sharecare (07/12/25)
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  • Registered Nurse , Case Manager…

    CVS Health (Nashville, TN)
    …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... using a keyboard **Preferred Qualifications** - 1+ years' Case Management experience or discharge planning, nurse navigator...lower levels of care - 1+ years' experience in Utilization Review - CCM and/or other URAC recognized accreditation… more
    CVS Health (08/01/25)
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  • Case Manager Registered Nurse - Specialty…

    CVS Health (Nashville, TN)
    …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... in **Specialty Pharmacy or Oncology.** **Preferred Qualifications** + 1+ years' Case Management experience or discharge planning, nurse navigator or nurse more
    CVS Health (08/01/25)
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  • Nurse Reviewer I

    Elevance Health (Nashville, TN)
    …in an ambulatory or hospital setting or minimum of 1 year of prior utilization management , medical management and/or quality management , and/or ... ** Nurse Reviewer I** **Location:** **Virtual:** This role enables...RN license in applicable state(s) required. + Familiarity with Utilization Management Guidelines, ICD-9 and CPT-4 coding,… more
    Elevance Health (07/26/25)
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