- Big South Fork Medical Center, Inc. (Knoxville, TN)
- …visits to referral facilities. Educate referral partners on swing bed criteria, services offered, and patient benefits. Plan and host educational events, luncheons, ... for referral partners to increase awareness and understanding of swing bed services . Represent the hospital at community events, healthcare meetings, and networking… more
- Community Health Systems (Franklin, TN)
- …it pertains to the areas of job responsibility. + Maintains performance metrics in line with Utilization Review Service Line KPIs. + May serve as a key ... Director, and Payor Relations Manager to facilitate coordination of services related to utilization review ....+ 3-5 years work experience in healthcare as a nurse required + 1-3 years work experience in Care… more
- Community Health Systems (Franklin, TN)
- …Knowledge of HIPAA regulations and patient confidentiality standards. **Licenses and Certifications** + RN - Registered Nurse - State Licensure and/or ... **Job Summary** The Clinical Utilization Review Specialist is responsible for...for evaluating the necessity, appropriateness, and efficiency of hospital services to ensure compliance with utilization management… more
- Veterans Affairs, Veterans Health Administration (Smyrna, TN)
- …of VHA and industry best standards. The Revenue Utilization review (RUR) Registered Nurse ( RN ) is an active member of the revenue cycle program ... level degree in Nursing may have opportunity to become registered as a nurse with a state...nursing experience. 1-3 years of relevant case management or utilization review experience. Ability to collaborate effectively… more
- Covenant Health Inc. (Knoxville, TN)
- Overview Registered Nurse Utilization Management PRN/OCC,Hours Vary, Day Shifts Covenant Health Overview: Covenant Health is the region's top-performing ... payors as applicable. + Completes daily work lists for utilization review meeting the time frames set...case management experience. Licensure Requirement: Current licensure as a Registered Nurse ( RN ) as issued… more
- Humana (Nashville, TN)
- …an impact** **Use your skills to make an impact** **Required Qualifications** + **Licensed Registered Nurse ( RN )** in the (appropriate state) with no ... medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are...in an acute care setting + Previous experience in utilization management/ utilization review for a… more
- CVS Health (Nashville, TN)
- …+ Perform medical necessity reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse with at least 1 year of experience in a hospital ... setting. + A Registered Nurse that holds an active, unrestricted...lower levels of care. + 1+ years' experience in Utilization Review . + CCM and/or other URAC… more
- Vanderbilt University Medical Center (Nashville, TN)
- …continuum of care. Conducts initial and/or concurrent utilization review medical necessity criteria. ... instead of emphasizing negative elements. **Position Qualifications:** **Responsibilities:** **Certifications:** LIC- Registered Nurse - Licensure-Others **Work Experience:** Relevant… more
- Quality Center for Rehabilitation and Healing (Lebanon, TN)
- …meaningful contributions to the rehab team conferences, patient care conferences, utilization review meetings, family conferences, and caregiver training ... a week 37.5 - 40 hours per week Respiratory Nurse ( RN ) We are searching for a...and clinical code of ethics and practice. . Implementing in- services and training. . Maintaining a current body of… more
- Fresenius Medical Center (Greeneville, TN)
- …direct reports. + Partners with internal Human Resources, Quality, and Technical Services departments. + Collaborates with or functions as the Home Therapies Program ... auditing activities. + Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. + Manages clinic… more
