RN Utilization Review Specialist
American Health Plans Inc.
American Health Plans in Franklin, TN seeks an Utilization Review Nurse to assess medical necessity and quality of care for plan members. You will support the Clinical Services Department and Medical Director to ensure services comply with regulatory guidelines.
The role requires RN licensure and UM experience; knowledge of Interqual/MCG and Medicare regulations is essential. Collaborative team environment, with focus on patient care coordination and regulatory compliance.
#J-18808-LjbffrVacancy posted 1 day ago
Similar jobs that could be interesting for youBased on the RN Utilization Review Specialist in Franklin, TN vacancy
- ...Revenue Specialist, Commercial Billing The Revenue Specialist, Commercial Billing investigates... .... Research, request, acquire, and review medical records, provider notes,... ...necessary for knowledge of account information. Utilizing information to manage claim life cycle...SuggestedRemote jobFlexible hours
- ...Southall Experience Specialist Southall is a premier destination bringing nature, produce... ...our guests with a 5-star experience and utilizing hotel systems to initiate service... ...the Southall standards. Monitor and review reservations prior to service to ensure...SuggestedWeekly payTemporary workWeekend workAfternoon shift
- ...within the scope of the Registered Nurse Practice Act. Utilizes therapeutic communication in daily practice. Maintains a... ...impact in our industry! Our Talent Acquisition team is reviewing applications for our RN Rehab PRN opening. Submit your application today and help...SuggestedFull timeTemporary workPart timeReliefFlexible hours
TriStar Skyline Medical Center
Franklin, TN1 day ago - ...colleagues in their positions. Join our Team as a RN Critical Care in the Neuro ICU Nights and... ...What you will do in this role: ~ Utilizes therapeutic communication in daily... ...for our RN Critical Care NVICU opening. We review all applications. Qualified candidates...SuggestedFull timeTemporary workPart timeFlexible hoursNight shift
TriStar Skyline Medical Center
Franklin, TN2 days ago - ...As a Acute Rehab RN, your voice to influence patient care is valued and empowered at... ...scope of the Registered Nurse Practice Act. Utilizes therapeutic communication in daily... ...apply for our Acute Rehab RN opening. We review all applications. Qualified candidates will...SuggestedTemporary workFlexible hours
TriStar Southern Hills Medical Center
Franklin, TN5 days ago - ...We are seeking a highly-skilled, experienced Payer Enrollment Specialist to join our growing team. Our ideal candidate will be deeply committed... ...systems such as CredentialStream or similar. Experience utilizing payer portals including Availity, CAQH, PECOS, NPPES, Medicare...Hourly payFull timeFor contractorsSeasonal work
Fast Pace Health
Franklin, TN5 days ago - ...Position Purpose: The Asset Protection Specialist is primarily responsible for preventing... ...assigned store/multiple stores. They utilize tools to minimize loss to the Company, including... ...incidents of theft and fraud, reviewing CCTV and exception reports, monitoring the...Local area
Home Depot
Spring Hill, TN2 days ago - ...eleven years. Position Summary The Provider Enrollment Specialist, Medicaid, has primary responsibility for oversight and... ...their enrollment status. Establish, maintain, and constantly review the accuracy of Out-of-State Medicaid requirements to ensure compliance...Flexible hours
EnableComp
Franklin, TN2 days ago - ...blueprints Test point-to-point functionality of systems Review project Scope of Work (SOW) to ensure quality and completeness... ...hardware and software AVIXA General CTS (Certified Technical Specialist) is preferred PHYSICAL REQUIREMENTS • Frequent standing,...For contractorsLocal area
AVI-SPL
Franklin, TN1 day ago - ...and point of care support. How you make a difference As a WFM Specialist I at Wellpath, you will hold a pivotal position in enhancing... ...management, and forecasting, all aimed at maximizing the efficient utilization of Wellpath's workforce management platforms. This role is...
Wellpath
Franklin, TN2 days ago - ...products and services in the Bank's call center. The Customer Service Specialist I is often the primary interaction a customer may have with the... ...complaints promptly and accurately. Attends a weekly quality review meeting for ongoing development including coaching, career...Bank staffWork at officeRemote workFlexible hours
WesBanco Bank Inc.
Franklin, TN2 days ago - ...Tennessee Orthopaedic Alliance Ar Specialist Tennessee Orthopaedic Alliance is the largest orthopaedic... ...solutions while analyzing patient accounts utilizing our EPM system Nextgen to determine appropriate action. Review explanations of benefits details on denials. Communicate...Work at office
$19 - $27 per hour
(USA) Member Specialist Sam's Club #6249 3070 Mallory Ln Franklin, TN 37067-8304 $19.00 - $27.00/hr* Full time Shifts may vary Position... ...a safe shopping environment. Maintains exit areas. Reviews member receipts. Acknowledges the member and identifies member...Hourly payMinimum wageFull timeTemporary workPart timeShift work$43 - $48 per hour
...a leading Engineering and construction firm. Supporting major utility projects across the country, you will work with an exceptional... ...education: Bachelors responsibilities: Analyze data, review logs, and run reports in the Enterprise Planning & Controls...Hourly payContract workTemporary workWork experience placementRandstad
Brentwood, TN5 days ago- ...Overseas Settlement Specialist I The Overseas Settlement Specialist I will assistance the Overseas Settlement Supervisor to meet and... ...receivable and payable to all assigned agents, accurately. Review agent's monthly AR statement and try to match up with our outstanding...Temporary workWork at officeLocal areaOverseasFlexible hours
$18 per hour
...centric to helping customers understand how to self-serve and utilize the T-Mobile app for wireless needs, you will deepen relationships... ...processes, and knowledge of systems and reference resources. Review your personal results, current promotions, and updates on the Hub...Hourly payFull timeTemporary workPart timeWork experience placementLocal areaFlexible hoursT Mobile US
Franklin, TN2 days ago$49.2k - $86.25k
...degree program and flexible post-licensure programs, such as the RN to BSN option, Master of Science in Nursing degree program,... ...Collaborating with academic partners, faculty and staff, the Specialist provides strategies and academic reinforcement to students throughout...Full timeWork at officeWorldwideFlexible hoursChamberlain University
Franklin, TN3 days ago$24 - $26 per hour
...Transfer Center Specialist II The Transfer Center Specialist II (LPN, Paramedic, EMT) will work remotely and coordinate through inbound... ...to facilitate the patient flow through the continuum of care utilizing electronic resources. Ability to document and prioritize...Full timeLocal areaRemote workFlexible hours$15 - $17.5 per hour
...procedures. • Maintains photo equipment and utilizes store systems and technology to support... ...continuity during times when the Photo Specialist is not scheduled. • Follows company... ...role will remain open until filled. To review benefits, please click here jobs.walgreens...Hourly payWork experience placementSeasonal workFlexible hoursAfternoon shift- ...Cardiac Monitor Specialist Fully Remote USHV - Corporate Main - Franklin, TN 37067 Overview Position Type: Full Time Job Shift... ...device performance, patient data, and any abnormal findings. Reviews and analyzes device data, including ECGs, event logs, and...Full timeRemote workShift work
$28.5 - $36.5 per hour
...and maintains the Optical area by following company procedures, utilizing equipment appropriately, merchandising, and completing... ...records in compliance with HIPAA and company procedures. Requests, reviews, and processes insurance claims and payments for doctor services...Hourly payMinimum wageFull timeTemporary workPart timeApprenticeshipShift work- ...(EHR) System (EPIC and Cerner knowledge preferred) Document Review and Redaction – Ability to review medical records for sensitive... ...when required. ~ Basic computer proficiency. ~ Comfortable utilizing phones, fax machine, printers, and other general office equipment...Full timeWork experience placementWork at officeLocal area
- ...Remote Physician Pro Fee Coder-Cardiology is responsible for reviewing, analyzing, and assigning accurate CPT, HCPCS, and ICD-10 codes... ...staff. Licenses and Certifications: CCS-Certified Coding Specialist (CCS-P) required or Certified Coder-AHIMA or AAPC or...Remote jobLocal area
- ...As a RN Med Surg, your voice to influence patient care is valued and empowered at every turn –whether through open, collaborative relationships... ...path, we encourage you to apply for our RN Med Surg opening. We review all applications. Qualified candidates will be contacted by a...Temporary workFlexible hoursShift work
TriStar Southern Hills Medical Center
Franklin, TN2 days ago - As a Acute Care RN , your voice to influence patient care is valued and empowered at every turn -whether through open, collaborative... ...path, we encourage you to apply for our Acute Care RN opening. We review all applications. Qualified candidates will be contacted by a member...Temporary workFlexible hoursShift work
TriStar Centennial Medical Center
Franklin, TN5 days ago - ...collaboration with medical providers and other members of the care team, the RN provides individualized, comprehensive, and compassionate care... ..., we encourage you to apply for our Neuro ICU Nurse opening. We review all applications. Qualified candidates will be contacted by a...Temporary workFlexible hours
TriStar Centennial Medical Center
Franklin, TN5 days ago - ...Hospice. We have an exciting and rewarding opportunity for a RN Hospice Executive Director to join our leadership team. This... ...and employees to establish goals and standards for performance; reviews and monitors progress regularly and redirects efforts where goals...Daily paidFull timeContract workTemporary workPart timeInterim roleWork at officeLocal areaImmediate startRelocation package
Gentiva Hospice
Franklin, TN1 hour ago - ...on call, no weekends, no holidays Seeking a Registered Nurse RN for our cardiology practice who provides clinical expertise to ensure... ...medications and treatment instructions You will maintain and review patients’ records including posting tests and examination results...Full timeTemporary workMonday to FridayFlexible hours
TriStar Cardiovascular Surgery
Franklin, TN5 days ago - ...interdisciplinary team in the development, review and revision of the clinical component of... .... Participates in quality improvement, utilization review, and infection control activities... ...corrective action. Requirements An active RN License in the state of application Valid...Full timeWork at officeMonday to FridayWeekend work
Aveanna Healthcare LLC
Franklin, TN1 day ago - ...patient-centered care. In collaboration with medical providers, the RN provides pre-operative and post-operative nursing care. The RN... ...we encourage you to apply for our RN Progressive Care opening. We review all applications. Qualified candidates will be contacted by a...Full timeTemporary workPart timeFlexible hoursShift work
TriStar Skyline Medical Center
Franklin, TN5 days ago
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to RN Utilization Review Specialist. Be the first to apply!
