Current jobs related to Market Director of Utilization Management - Nashville - Ascension

  • DentaQuest

    Director, Utilization Management

    1 week ago

    DentaQuest Nashville

    You are as unique as your background, experience and point of view. Here, you'll be encouraged, empowered and challenged to be your best self. · Dynamic colleagues - experts in their fields - who are eager to share their knowledge with you. · Your leaders will inspire and help yo ...

  • Ascension

    Market Director of Utilization Management

    5 days ago

    Ascension Nashville

    Director of Utilization Management Job Summary · The Director of Utilization Management will lead clinical discussions during Payer JOC meetings, oversee denial management activities, and perform root-cause analysis to enhance our processes. · Key Responsibilities · Ensure integr ...

  • Cannon and Cannon, Inc.

    Utilities Project Engineer/Project Manager

    1 day ago

    Cannon and Cannon, Inc. Nashville

    Overview · Key Responsibilities: · Lead, manage, and execute water and wastewater infrastructure projects, including planning, design, permitting, and construction completion. · Conduct engineering analyses and prepare detailed technical reports, drawings, and specifications for ...

  • Medical Solutions

    Travel Nurse RN

    1 day ago

    Medical Solutions Nashville

    Job Title: · Travel Nurse RN Case Manager, Utilization Review · Job Summary: · We are seeking a skilled and compassionate Travel Nurse RN Case Manager, Utilization Review to join our team. As a key member of our healthcare staff, you will be responsible for reviewing medical reco ...

  • Medical Solutions

    Travel Nurse RN

    1 day ago

    Medical Solutions Nashville

    Job Summary · A travel nurse RN Case Manager, Utilization Review position is available with a top healthcare facility in Nashville, Tennessee. This 13-week assignment offers a challenging and rewarding opportunity for experienced nurses to utilize their clinical skills in a fast- ...

  • i3 Verticals Management Services, Inc.

    Sr. Technical Solution Consultant

    1 day ago

    i3 Verticals Management Services, Inc. Nashville Full time

    Job Description · Solution Consultant - Corporate Utilities Technical Consultant · Department: Public Sector Utility Practice · Reports to: Utilities Service Manager · Job Location: Remote (US Based) · Travel: Up to 50% · A Utility focused Solution Consultant will work closely wi ...

  • Medical Solutions

    Travel Nurse RN

    18 hours ago

    Medical Solutions Nashville

    We are seeking a travel nurse RN Case Manager, Utilization Review for a temporary position in Nashville, Tennessee. · Job Description & Requirements · Specialty: Utilization Review · Discipline: RN · Duration: 13 weeks · Hours per week: 36 · Shift: Days (8 hours) · We offer flexi ...

  • Exact Sciences Careers

    Regional Oncology Specialist- Mid South

    15 hours ago

    Exact Sciences Careers Nashville

    Regional Oncology Specialist - Mid South · The Regional Oncology Specialist II at Exact Sciences promotes cancer diagnostic products to healthcare providers, driving sales and maximizing product utilization within targeted territories. This role requires strong clinical and scien ...

  • Insight Global

    Fire Alarm Inspector

    2 days ago

    Insight Global Nashville

    Job Title: Fire Alarm Inspector · A seasoned professional is sought after to conduct fire alarm inspections at various sites in the Nashville area. The ideal candidate will possess expertise in generating and managing inspection reports using a barcode scanning system, as well as ...

  • Cross Country Nurses

    Travel Nurse RN

    1 day ago

    Cross Country Nurses Nashville

    Job Title: Travel Nurse RN Case Management · Cross Country Nurses is seeking a travel nurse RN Case Management for a travel nursing job in Nashville, Tennessee. · Job Requirements and Details · Specialty: Case Management · Discipline: RN · Duration: 13 weeks · Hours per week: 40 ...

  • Vanderbilt University

    Engineer

    19 hours ago

    Vanderbilt University Nashville

    The Engineer plays a vital role in the Facilities Engineering team within Vanderbilt University's Facilities Maintenance & Operations Department. This team supports campus planning and operations to ensure a safe, park-like, invigorating, comfortable, efficient, and sustainable e ...

  • Medical Solutions

    Travel Nurse RN

    1 day ago

    Medical Solutions Nashville

    Travel Nurse RN Case Manager, Utilization Review · Medical Solutions is seeking a talented and adventurous Registered Nurse (RN) to fill a 13-week travel nursing position in Nashville, Tennessee. · Job Requirements: · Specialty: Utilization Review · Discipline: RN · Duration: 13 ...

  • Pilgrim's

    senior project engineer

    1 day ago

    Pilgrim's Nashville

    Description · Sr. Project Engineer · Job Overview: · The Sr. Project Engineer is responsible for overseeing various projects at Processing Plants. Working closely with Engineering, Plant personnel and Contractors, the Project Engineer will guide the projects to completion accordi ...

  • Evolent

    Field Medical Director, Genetic Testing

    1 week ago

    Evolent Nashville

    Evolent Field Medical Director, Genetic Testing · We partner with health plans and providers to achieve better outcomes for people with complex and costly health conditions. We seek to connect the pieces of the fragmented healthcare system, ensuring individuals receive the same l ...

  • W Talent

    Substation Engineer

    2 days ago

    W Talent Nashville

    Our client, a respected power delivery engineering consultancy, seeks an experienced Substation Engineer to join their team. The ideal candidate has 4-10 years of experience in Physical Design or Protection & Control (P&C) design for substations up to 500kV. · Job Description · T ...

  • Williamson Health

    Registered Nurse

    1 week ago

    Williamson Health Nashville Full time

    As a Registered Nurse in the Oncology unit at Williamson Health, I am responsible for coordinating and implementing timely nursing care for patients. My role requires a strong commitment to compassionate care, utilizing my nursing skills and knowledge to assess, plan, and manage ...

  • Feintool Tennessee

    Quality Engineer

    4 days ago

    Feintool Tennessee Nashville Full time

    Job Title · Summary of Function · As a Quality Engineer, you will play a crucial role in coordinating and completing activities for new program launches, facilitating problem-solving for internal and external quality issues, and developing and maintaining systems to support manuf ...

  • Newport Healthcare

    Utilization Review Specialist

    13 hours ago

    Newport Healthcare Nashville

    About Newport Healthcare: · We are a nationwide behavioral healthcare organization dedicated to transforming young lives through evidence-based care. · Job Description: · The Utilization Review Specialist plays a crucial role in managing client caseloads, collaborating with the C ...

  • Brenntag

    Account Manager

    1 week ago

    Brenntag nashville

    Job Title: Account Manager · About the Role: · We are seeking an experienced and results-driven Account Manager to join our team in Nashville. As an Account Manager, you will be responsible for managing sales efforts in your assigned territory to maximize sales and profit. · Your ...

  • BL Companies

    Civil Engineer – Senior Technical

    1 week ago

    BL Companies nashville

    Civil Engineer – Senior Technical · BL Companies is 100% employee owned, giving us a competitive edge and a unique distinction from most other companies. We offer a competitive benefit package including 6 paid holidays, generous PTO, Medical, Dental and Vision insurance, disabili ...

  • Humana

    Medical Director

    1 week ago

    Humana Nashville-Davidson

    Becoming a part of our caring community helps us prioritize health. · The Medical Director utilizes medical background, experience, and judgement to make determinations about requested services, care levels, and service sites. All work is conducted within the context of regulator ...

    • Market Director of Utilization Management - Nashville - Ascension

    Ascension
    Ascension Nashville

    1 month ago

    Ascension background
    Description

    Director of Utilization Management

    We are seeking an experienced Director of Utilization Management to lead clinical discussions during Payer JOC meetings, oversee denial management activities, and perform root-cause analysis to enhance our processes.

    This role requires a collaborative leader who can work with Market Care Management, Finance, CDI, and Physician Advisors to identify and implement technology improvements. You will facilitate cross-functional meetings to drive collaboration and efficiency, lead strategic initiatives in utilization management to optimize patient care, and partner with the National Senior Director of UM to align on organizational goals.

    This position is based in Nashville, TN, with some traveling required to Ascension Saint Thomas hospitals throughout the TN market.

    Responsibilities:

    • Provide strategic direction and oversight of the day-to-day operations of utilization management function within the insurance plan.
    • Ensure integration of utilization management functions with network strategy and claims processing.
    • Oversee work with provider relations on resolving issues.
    • Manage activities related to staffing, including hiring, orienting, evaluating, disciplinary actions, and continuing education initiatives.
    • Develop systems and processes for prospective, concurrent and retrospective utilization review for all self-funded and fully insured clients to implement and manage comprehensive outpatient and inpatient utilization management programs.
    • Oversee implementation and maintenance of prior authorization codes for all clients.

    Requirements:

    • Licensure / Certification / Registration: Registered Nurse credentialed from the Tennessee Board of Nursing obtained prior to hire date or job transfer date required.
    • Education: Bachelor's degree in nursing or diploma from an accredited school/college of nursing required. Master's degree or combination of Bachelor's degree and experience preferred.
    • Work Experience: 5 years of experience required. 10 years of experience preferred. 2 years of leadership or management experience required. 5 years of leadership or management experience preferred.

    Estimated Salary: $120,000 - $150,000 per year

    About Our Company:

    A leading health care system with a 125-year history of providing care to the community, Ascension Saint Thomas offers a highly comprehensive system of care, with more than 250 sites of care that cover a 45-county area in Tennessee consisting of 16 hospitals and a network of affiliated joint ventures, medical practices, clinics and specialty facilities.

    We are committed to delivering compassionate, personalized care to all, with special attention to persons living in poverty and those most vulnerable. We are an equal opportunity employer and offer many benefits to help support the well-being of our military families, spouses, veterans and reservists.

Jobs
>
Nashville
>
Market director of utilization management