utilization review jobs in Nashville, TN

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Medical Review Nurse
NCI Information Systems, Inc. 94 reviews - Nashville, TN
Review Nurse ( Medical Reviewer III ) , you will primarily be responsible for conducting clinical reviews... years utilization/quality assurance review and ICD-9...
Sponsored by NCI Information Systems, Inc. - 6 days ago
TriStar Centennial Medical Center - Registered Nurse (RN) -...
USr Healthcare - Nashville, TN
Nurse (RN) - Utilization Review - PRN Our 657 bed... Review - PRN. Responsibilities: * The Utilization Review Nurse performs medical necessity reviews on all...
Sponsored by NurseJobsNationwide.com - 12 days ago

Case Coordinator

Cigna 629 reviews - Nashville, TN
Strong interpersonal skills with capacity to project warmth & empathy. Current licensure as a Licensed Practical Nurse (LPN) or Licensed Vocational Nurse (LVN)...
2 days ago - save job - block - email - more...

Patient Centered Medical Home (PCMH) Coordinator - Middle TN

BlueCross BlueShield of Tennessee 26 reviews - Nashville, TN
The focus of the PQIP Care Coordinator is to promote whole person health support to the member with emphasis on establishment of routine contact with his/her...
5 days ago - save job - block - email - more...

Clinical Reviewer - Appeals

Ascend Management Innovations - Franklin, TN 37067
This involves sitting through telephonic hearings that can sometimes involve dealing with difficult people, such as judges and/or atttorneys....
Easily apply
5 days ago - save job - block - email - more...

Medical Review Nurse

NCI Information Systems, Inc. 94 reviews - Nashville, TN
Ability to read Medicare claims, both paper and electronic, and a basic knowledge of the Medicare claims systems....
6 days ago - save job - block - email - more...

RN Utilization Review Nurse - Nashville, TN

Cigna 629 reviews - Nashville, TN
Updates as needed. Prepares IRE case file when requests are received for Tech CM appeals. (for example - tiering exception appeals/continuation of SNF.)....
5 days ago - save job - block - email - more...

Clinical Documentation Specialist

Sumner Regional Medical Center 14 reviews - Gallatin, TN
Minimum of 5 years experience adult inpatient medical/surgical or critical care with 1 year of experience as a CDS....
13 days ago - save job - block - email - more...

Medical Reviewer III

CGS Administrators 5 reviews - Nashville, TN
Ability to work independently, prioritize effectively and make sound decisions. Working knowledge of managed care and various forms of health care delivery...
2 days ago - save job - block - email - more...

RN Onsite Review Nurse - Memphis, TN

Humana 597 reviews - Brentwood, TN
Humana is seeking a Clinical RN Advisor for Onsite Review who will collaborate with other health care givers in reviewing actual and proposed medical care and...
19 days ago - save job - block - email - more...

Registered Nurse II

Cigna 629 reviews - Nashville, TN
RN, active RN license without restrictions, as well as previous clinical experience (at least 2 years preferred);....
5 days ago - save job - block - email - more...

Case Mgr

Skyline Medical Center 7 reviews - Nashville, TN
Demonstrated skill in problem solving, critical thinking, and negotiation. Identifies discharge needs. Coordinates Discharge Planning meetings....
HCA Inc - 6 days ago - save job - block - email - more...
Preservice Review Nurse RN (Telecommuting in Brentwood, TN)
UnitedHealth Group 1,357 reviews - Brentwood, TN
pdf This Preservice Review Nurse is a Telecommuting... Responsibilities include: Perform utilization and concurrent review using Milliman criteria Conduct...
Sponsored by UnitedHealth Group - 16 days ago
Telephonic Transplant RN Case Manager - Work from home in TN
UnitedHealth Group 1,357 reviews - Brentwood, TN
and conduct clinical reviews of members. In addition... Case Manager (CCM) Experience in utilization and/or concurrent review Careers with Optum. Here's the...
Sponsored by UnitedHealth Group - 5 days ago
Clinical Reviewer - Appeals
Ascend Management Innovations - Franklin, TN
utilization review for contract services, determining medical level of care (LOC) for TennCare Medicaid. ESSENTIAL FUNCTIONS 1. Conducts utilization review of...
Easily apply
Sponsored by Ascend Management Innovations - 5 days ago
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1,357 reviews
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