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Licensed Practical Nurse - Clinical Reviewer - Franklin, TN
Reviews clinical information submitted by providers to appropriate criteria and standards and makes decision to issue a review determination or to refer to...
Desired Experience: Managed Care
RN Manager - Case Management
Serves as content specialist for staff in the areas of utilization criteria, appeal and review process, and case management system documentation....
Desired Experience: RN
Operating Room Nurse Coordinator
Premier ASC - 186 reviews - Nashville, TN
Operating Room Nurse Coordinator(Job Number:. Performs nurse circulator duties as assigned. Consistently reviews charts for completeness, in accordance with...
Desired Experience: RN, BLS Certification, PALS Certification, ACLS Certification

Utilization Review Nurse F-T Weekends REMOTE OPPORTUNITY Fri...

MedManagement LLC - Chattanooga, TN
Our nurses work with a strong group of board certified practicing physicians, skilled administrators and a state of the art technical staff to review medical...
Desired Experience: RN, BC/BE
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Medical Claims Review Nurse RN

UnitedHealth Group - 11,739 reviews - Tennessee
Background involving utilization review for an insurance company or experience in case management. The posting is for applicants to be considered Preservice...
Desired Experience: RN, Microsoft Office, Case Management

Utilization Review RN (Retro Review/Precert) - Onsite/Nashvi...

Cigna - 3,039 reviews - Nashville, TN
Responsible for outreaching and educating providers on Retro Review processing as well as explaining any Retro Review Dismissal....
Desired Experience: Time Management, RN

Clinical Coverage Review Medical Director

UnitedHealth Group - 11,739 reviews - Tennessee
5+ years hands-on experience in utilization and coverage review in a health plan with Commercial membership. Clinical Coverage Review Medical Director....
Desired Experience: Microsoft Word, BC/BE, Project Management, Managed Care

Retro Review Precert Nurse LPN - Nashville

Cigna - 3,039 reviews - Nashville, TN
Current licensure as a Licensed Practical Nurse LPN or Licensed Vocational Nurse LVN. Responsible for the effective and sufficient support of all Utilization...
Desired Experience: Time Management, Microsoft Powerpoint, Microsoft Office, LVN

Clinical Documentation Specialist

West Tennessee Healthcare - 29 reviews - Tennessee
 Current licensure as Registered Nurse. Evaluate the utilization and documentation of acute care services. Specific reviews are determined both internally and...
Desired Experience: Clinical Documentation Certification, Documentation Review, Physiology Knowledge, RN, BLS Certification

Executive Director of Utilization Review

Strategic Behavioral Health, LLC - 143 reviews - Memphis, TN
Reporting to the Vice President of Finance and/or a member of the senior management team, The Executive Director of Utilization Review provides facility-wide...
Desired Experience: Case Manager Certification, RN, Managed Care

Case Manager

West Tennessee Healthcare - 29 reviews - Tennessee
Educational resource to all WTH staff regarding utilization review. Preferred experience in care facilitation and management and utilization review....
Desired Experience: Case Manager Certification, RN, Case Management, BLS Certification

Care Management Case Managers

West Tennessee Healthcare - 29 reviews - Tennessee
 Preferred experience in care facilitation and management and utilization review. Utilization review changes, authorization changes, contract changes,...
Desired Experience: Case Manager Certification, RN, Case Management, BLS Certification

Clinical Program Optimization Specialist

Amedisys, Inc. - 1,011 reviews - Tennessee
Current, unencumbered license to practice as a Registered Nurse or Physical Therapist. Pathway selection and documentation, supply utilization, implementation...
Desired Experience: Program Development, RN, Home Care
Director of Case Management - Sign On Bonus
Registered Nurse (RN) preferred, other backgrounds considered. As the Director of Case Management, you will use your clinical knowledge every day and...
Desired Experience: RN, Social Work Certification, Management Experience, Case Management, Leadership Experience
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Registered Nurse (RN)-Quality Coordinator
Registered Nurse (RN)-Quality Coordinator(Job Number:. Designs and analyzes physicians’ trending reports that include resource utilization....
Desired Experience: RN