- CVS Health (Nashville, TN)
- …with transferring patients to lower levels of care. + 1+ years' experience in Utilization Review . + CCM and/or other URAC recognized accreditation preferred. + ... in 1993, AHH is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that support… more
- Fresenius Medical Center (Knoxville, TN)
- …AND SCOPE:** Supports FMCNA's mission, vision, core values and customer service philosophy. Adheres to the FMCNA Compliance Program, including following all ... Facilitate timely workup of patients for access management, dialysis services , patient education, hospitalizations, and kidney transplantation as appropriate, and… more
- Fresenius Medical Center (Smyrna, 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
- Lebanon 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 ... standards of conduct and clinical code of ethics and practice. . Implementing in- services and training. . Maintaining a current body of knowledge in areas of… more
- Community Health Systems (Franklin, TN)
- **Job Summary** The Clinical Utilization Review Specialist is responsible for evaluating the necessity, appropriateness, and efficiency of hospital services ... with healthcare providers to facilitate efficient patient care. The Clinical Utilization Review Specialist monitors adherence to hospital utilization… more
- CenterWell (Kingsport, TN)
- …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and ... Clinical Manager** coordinates and oversees all direct care patient services provided by clinical personnel. This role is a...requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking… more
- Sevita (TN)
- …us today, and experience a career well lived. **State Clinical Director, IDD Services ** **Starting Pay $110k** ** Registered Nurse license required; travel is an ... of states in support of residential or vocational programs, or an independent clinical service line. + Services and Support: + Oversee clinical team as assigned… more
- Prime Therapeutics (Nashville, TN)
- …clinical experience. + Experience in managed care, specialty drugs, care management and utilization review . + Meets Credentialing criteria. + At minimum must ... REMOTE **Job Description** Under supervision, is responsible for performing referral services to support independent physician offices with maintaining member drug… more
- Covenant Health Inc. (Knoxville, TN)
- …Provides care management services within the scope of practice as a registered nurse meeting all required standards both legal and regulatory. Education: + In ... Overview Registered Nurse Care Manager, Continuum of Care Full...home. In addition to providing the area's leading cardiac services , Parkwest has been nationally recognized for award-winning care… more
- Community Health Systems (Powell, TN)
- …clinical nursing experience required + 3-5 years of experience in care management or utilization review required + 1-3 years of leadership experience in a ... Conducts chart reviews to evaluate severity of illness (SI) and intensity of services (IS) for admissions, continued stays, and discharge planning. + Refers cases… more
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