utilization review jobs in Nashville, TN

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Licensed Utilization Review II (Call Center Nurse)- Nashvill...
Anthem, Inc. - 2,802 reviews - Nashville, TN 37201
2 years of acute care or utilization review experience; Review of claim edits, pre-noted inpatient admissions or, episodic outpatient therapy such as physical...
Registered Nurse (RN)-Quality Coordinator
Designs and analyzes physicians’ trending reports that include resource utilization. Coordinates Peer Review and comparative physician PI Outcomes Data into the...
Patient Care Coordinator
Bulow Orthotic & Prosthetic Solutions - Nashville, TN 37203
Takes patient height, weight and reviews relevant medical history with patient. Patient Care Coordinator*....
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Nurse Auditor
Xsolis - Nashville, TN
Case Management and/or Utilization Review experience a must. 2+ years of auditing or medical review experience....

Registered Nurse - Clinical Reviewer - Franklin, TN

eviCore healthcare - 187 reviews - 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...

Utilization Review Specialist (Nurse)

Aspire Health - 37 reviews - Nashville, TN 37203
While performing the duties of this job, the Utilization Review Specialist is regularly required to talk or hear....

Appeals Coordinator

Cardinal Health - 2,397 reviews - Brentwood, TN 37027
Reviews NOMNC for validity prior to processing appeal request. At least two years’ recent experience in case-management or utilization management....

Appeals Coordinator

naviHealth - 38 reviews - Brentwood, TN 37027
Reviews NOMNC for validity prior to processing appeal request. At least two years’ recent experience in case-management or utilization management....

Nurse Practicioner Fellow (Transplant)

Vanderbilt University Medical Center - 333 reviews - Nashville, TN 37232
Becker's Hospital Review:. Reviews data and evidences to improve advanced practice. Additionally, an expanded incorporation of evidenced-based practice into...

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

Cigna - 2,894 reviews - Nashville, TN
Responsible for outreaching and educating providers on Retro Review processing as well as explaining any Retro Review Dismissal....

Nurse Auditor

Xsolis - Nashville, TN
Case Management and/or Utilization Review experience a must. 2+ years of auditing or medical review experience....

Nurse Auditor - Claims

XSolis - Nashville, TN 37217 (Una area)
Case Management and/or Utilization Review experience a must. 2+ years of auditing or medical review experience....
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Inpatient Care Nurse

WellCare - 885 reviews - Brentwood, TN 37027
Required 2 years of experience in a clinical setting with general nursing exposure in utilization management to include pre-authorization, utilization review,...

Field RN Case Manager - Nashville (Dual Eligible Members)

Cigna - 2,894 reviews - Nashville, TN
Provides clinical assessments, health education, and utilization management to members. Performs prospective, concurrent, and retrospective reviews for...
Utilization Review Administrative Assistant
Aspire Health - 37 reviews - Nashville, TN 37203
The Utilization Review Administrative Assistant serves as a clinical administrator to our Care Center’s team of Registered Nurses....
Director of Case Management - Sign On Bonus
, you will use your clinical knowledge every day and contribute to the overall functions and professional growth of the Department including yet not limited to...
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