Nurse for Utilization Management

2 weeks ago


Nashville, Tennessee, United States Nashville General Hospital Full time


Nashville General Hospital is seeking a Utilization Management Nurse on a PRN Basis

The Utilization Management Nurse will oversee the Prior Authorization process for all ancillary services and procedures conducted at the Hospital or in Clinics. This role involves collaboration with procedural areas, clinics, physicians, and insurance providers to ensure that necessary authorizations are secured prior to scheduled tests or procedures. The nurse will also be responsible for verifying authorizations obtained by external providers and institutions, as well as obtaining retroactive authorizations when changes in tests or procedures occur. Additionally, the nurse will work with contracting to secure Single Case Agreements as needed and document authorizations in conjunction with our claims and billing contractors. The position also includes managing the in-house authorization process for observation and inpatient hospital stays, reviewing observation cases for potential conversion to inpatient status, and communicating with hospital teams regarding these conversions and authorizations. Furthermore, the nurse will aid in tracking and trending of denials and weekly unbilled claims. *This position requires working 4 weekend days a month (4-8 hour shifts) along with 1 summer and 1 winter holiday. There is potential to work 1-2 shifts a week as well.*

As a Utilization Management Nurse, your responsibilities will include:
  • Reviewing daily schedules to identify tests, procedures, and appointments requiring authorization.
  • Contacting insurance companies to obtain prior authorization via phone, fax, or online portals.
  • Documenting results of prior authorization requests.
  • Coordinating with the ordering office, practitioner, and performing department when additional information is required for authorization or when authorization is denied.
  • Communicating with external providers or institutions when authorization is not found to be active or has not been obtained when necessary.
  • Participating in discussions regarding denials and unbilled claims to eliminate barriers and reduce denials.
  • Reviewing daily census.
Required Skills & Qualifications:
  • Graduate of an accredited nursing program.
  • Active license to practice as a registered nurse in the state of Tennessee.
About Nashville General Hospital

Nashville General Hospital (NGH) is Nashville's original community-based hospital. Joint Commission accredited, NGH accommodates a wide range of needs from emergency services and acute care to ancillary and ambulatory services. NGH maintains a strong commitment to the healthcare needs of Nashville and Davidson County's underserved populations while providing care to all segments of the community.

Our benefits include:
  • Metro Health Incentive Program - Access to high-quality healthcare without incurring out-of-pocket expenses.
  • Flexible Spending Accounts.
  • Free parking for all employees.
Nashville General Hospital is an Equal Opportunity Employer/Disability/Veteran.

We are an E-Verify employer.

For more information, please refer to the following links:
E-Verify Participation Poster: English Spanish
E-Verify Right to Work Poster: English Spanish

  • Nashville, Tennessee, United States Nashville General Hospital Full time

    Nashville General Hospital is seeking a Nurse for Utilization Management on a PRN Basis The Nurse in Utilization Management will oversee the Prior Authorization process for all ancillary services and procedures conducted at the Hospital or in Clinics. This role involves coordinating with procedural areas, clinics, physicians, and insurance providers to...

  • Travel Nurse

    2 days ago


    Nashville, Tennessee, United States UnitedHealth Group Full time

    Job SummaryUnitedHealth Group is seeking a highly skilled Travel Nurse to join our team as a Case Manager/Utilization Review. This is a 100% travel position that requires the ability to work remotely from anywhere within the U.S. and take on some tough challenges.Key ResponsibilitiesProvide comprehensive care management or utilization review services in...


  • Nashville, Tennessee, United States Penn Foster Inc Full time

    Position Overview:The Energy Analyst role within the Office of Energy Programs is designed to support the State Facility Utility Management team in overseeing the Utility Data Management (UDM) platform for state facilities. This position emphasizes the importance of data accuracy, focusing on utility billing, facility information, and end-user data...


  • Nashville, Tennessee, United States i3 Verticals Management Services, Inc. Full time

    Job OverviewPOSITION TITLE: Business AnalystDIVISION: Enterprise Solutions – Utility SectorSUPERVISOR: Enterprise Services Manager – UtilitiesWORK LOCATION: Remote (US Based)TRAVEL REQUIREMENTS: Up to 25%POSITION SUMMARY:The Business Analyst plays a crucial role in evaluating business needs and converting them into technical requirements. This includes...


  • Nashville, Tennessee, United States i3 Verticals Management Services, Inc. Full time

    Job OverviewPOSITION TITLE: Business AnalystDIVISION: Enterprise Solutions – Utility SectorSUPERVISOR: Enterprise Services Manager – UtilitiesWORK LOCATION: Remote (US Based)TRAVEL REQUIREMENTS: Up to 25%POSITION SUMMARY:The Business Analyst plays a crucial role in assessing business needs and converting them into technical documentation. This includes...


  • Nashville, Tennessee, United States i3 Verticals Management Services, Inc. Full time

    Job OverviewPOSITION TITLE: Business AnalystDIVISION: Enterprise Solutions – Utility SectorSUPERVISOR: Enterprise Services Manager – UtilitiesWORK LOCATION: Remote (US Based)TRAVEL REQUIREMENTS: Up to 25%POSITION SUMMARY:The Business Analyst plays a crucial role in evaluating business needs and converting them into technical documentation. This includes...


  • Nashville, Tennessee, United States Ascension St. Thomas Behavioral Health Hospital Full time

    Job SummaryAscension St. Thomas Behavioral Health Hospital is seeking a skilled Utilization Specialist to join our team. As a Utilization Specialist, you will play a critical role in optimizing reimbursement for our facility and ensuring the highest quality of care for our patients.Key ResponsibilitiesMonitor patient length of stay and extensions, and inform...


  • Nashville, Tennessee, United States Center for Nonprofit Management Full time

    Job SummaryThe Center for Nonprofit Management seeks a skilled Volunteer Program Manager to oversee the development and implementation of volunteer programs that benefit older adults and adults with disabilities. This is an exciting opportunity to join a dynamic team and make a meaningful impact in the community.Key ResponsibilitiesDevelop and implement...


  • Nashville, Tennessee, United States Center for Nonprofit Management Full time

    Job SummaryThe Center for Nonprofit Management seeks a highly motivated and organized individual to serve as a Community Engagement and Volunteer Leader. This role is designed to foster strong relationships with the local community, promote volunteer engagement, and support the mission of the organization.Key ResponsibilitiesRecruit, manage, and retain a...


  • Nashville, Tennessee, United States Newport Healthcare Full time

    About the RoleNewport Healthcare is a leading provider of behavioral healthcare services, dedicated to delivering high-quality care to young people and their families. We are seeking a skilled Clinical Utilization Specialist to join our team, responsible for managing an active caseload of clients and ensuring seamless communication with insurance companies,...


  • Nashville, Tennessee, United States Center for Nonprofit Management Full time

    Job SummaryThe Center for Nonprofit Management is seeking a highly skilled and compassionate Family Counselor to join our team. As an MST Family Counselor, you will play a critical role in providing community-based treatment for families of juveniles involved in the juvenile justice system.Key ResponsibilitiesCarry a caseload of 4-5 families, providing...


  • Nashville, Tennessee, United States Center for Nonprofit Management Full time

    Job Title: Family Support CounselorCompany: Center for Nonprofit ManagementThe Family Support Counselor role is centered around providing essential assistance to families of adolescents who are either involved in or at risk of entering the juvenile justice system. This position employs a comprehensive therapeutic framework that emphasizes the importance of...


  • Nashville, Tennessee, United States Center for Nonprofit Management Full time

    Job Title: Family Support CounselorCompany: Center for Nonprofit ManagementThe Family Support Counselor plays a vital role in delivering effective therapeutic services aimed at assisting families with young individuals who are either involved in or at risk of engaging with the juvenile justice system. This position emphasizes the importance of addressing...


  • Nashville, Tennessee, United States Center for Nonprofit Management Full time

    Job Title: Family Support CounselorCompany: Center for Nonprofit ManagementThe Family Support Counselor plays a crucial role in providing assistance to families with adolescents who are either involved in or at risk of entering the juvenile justice system. This position utilizes a comprehensive therapeutic model that emphasizes the importance of the family...

  • Travel Nurse RN

    10 hours ago


    Nashville, Tennessee, United States Nurse First Full time

    Job SummaryNurse First is seeking a skilled travel nurse RN to fill a Med Surg position in a dynamic healthcare setting.Key ResponsibilitiesProvide high-quality patient care as a Med Surg nurse, utilizing strong clinical skills and knowledge.Collaborate with interdisciplinary teams to develop and implement effective patient care plans.Contribute to a...

  • Travel Nurse RN

    1 day ago


    Nashville, Tennessee, United States Nurse First Full time

    Job SummaryNurse First is seeking a skilled travel nurse RN to fill a Med Surg position in a dynamic healthcare setting.Key ResponsibilitiesProvide high-quality patient care as a Med Surg nurse, utilizing strong clinical skills and knowledge.Collaborate with interdisciplinary teams to develop and implement effective patient care plans.Contribute to a...

  • Sales Director

    3 days ago


    Nashville, Tennessee, United States ElectriCom Inc Full time

    Job DescriptionElectriCom Inc, a leading Utility Construction company, is seeking a highly skilled Sales Director to support our construction management teams in developing and nurturing relationships with power distribution utility providers and other power utility providers in our construction regions.Key ResponsibilitiesBusiness Development: Obtain new...

  • Travel Nurse RN

    1 day ago


    Nashville, Tennessee, United States Nurse First Full time

    Job SummaryNurse First is seeking a skilled travel nurse to join our team in a CCU - Coronary Care setting. As a travel nurse, you will have the opportunity to work in a dynamic and challenging environment, providing high-quality patient care and contributing to the success of our healthcare team.Key ResponsibilitiesProvide exceptional patient care in a CCU...


  • Nashville, Tennessee, United States Hornbuckle Plumbing Company, New Installations Full time

    Position OverviewCompensation: Pay is commensurate with experience, starting at $25.00 per hour.Key Responsibilities:Proficient in operating various commercial machinery including dump trucks, backhoes, trackhoes, and skid steers.Conduct repairs on existing plumbing systems.Install water and sewer taps along with utility infrastructure.Qualifications:Prior...


  • Nashville, Tennessee, United States Center for Nonprofit Management Full time

    Job SummaryThe Center for Nonprofit Management is seeking a skilled Certified Nursing Assistant to join our team. As a key member of our healthcare support staff, you will play a vital role in providing exceptional patient care and support services.Key ResponsibilitiesAssist nurses with patient care activities, including vital sign monitoring, toileting, and...