Analyze utilization trends to ensure progress towards organizational goals * Educates healthcare providers and patients regarding appropriate levels of care and service criteria and guidelines.
Analyze utilization trends to ensure progress towards organizational goals * Educates healthcare providers and patients regarding appropriate levels of care and service criteria and guidelines.
Analyze utilization trends to ensure progress towards organizational goals * Educates healthcare providers and patients regarding appropriate levels of care and service criteria and guidelines.
Analyze utilization trends to ensure progress towards organizational goals * Educates healthcare providers and patients regarding appropriate levels of care and service criteria and guidelines.
Analyze utilization trends to ensure progress towards organizational goals * Educates healthcare providers and patients regarding appropriate levels of care and service criteria and guidelines.
Analyze utilization trends to ensure progress towards organizational goals * Educates healthcare providers and patients regarding appropriate levels of care and service criteria and guidelines.
Manager of Utilization Review
Franklin, TN · On-site
$90 - $120/hr
The Manager of Utilization Review (UR) manages the daily operations of the UR practices for an ... Demonstrates strong problem solving and analytical skills. * Demonstrates the ability to ...
Manager of Utilization Review
Franklin, TN · On-site
$90 - $120/hr
The Manager of Utilization Review (UR) manages the daily operations of the UR practices for an ... Demonstrates strong problem solving and analytical skills. * Demonstrates the ability to ...
The Manager of Utilization Review collaborates with leaders throughout the company to support ... Demonstrates strong problem solving and analytical skills. * Demonstrates the ability to ...
The Manager of Utilization Review collaborates with leaders throughout the company to support ... Demonstrates strong problem solving and analytical skills. * Demonstrates the ability to ...
Manager of Utilization Review
Franklin, TN · On-site +1
The Manager of Utilization Review collaborates with leaders throughout the company to support ... Demonstrates strong problem solving and analytical skills. * Demonstrates the ability to ...
Manager of Utilization Review
Franklin, TN · On-site +1
The Manager of Utilization Review collaborates with leaders throughout the company to support ... Demonstrates strong problem solving and analytical skills. * Demonstrates the ability to ...
Utilization Review Specialist
Nashville, TN · Remote
$62K - $70K/yr
Strong analytical, communication, and documentation skills * Proficiency with electronic medical records (EMR) and utilization management systems * Understanding of HIPAA and patient confidentiality ...
Utilization Review Specialist
Nashville, TN · Remote
$62K - $70K/yr
Strong analytical, communication, and documentation skills * Proficiency with electronic medical records (EMR) and utilization management systems * Understanding of HIPAA and patient confidentiality ...
Utilization Management Representative I Utilization Management Representative I Location : This ... and analytical skills. Job Level: Non-Management Non-Exempt Workshift: Job Family: CUS > Care ...
Utilization Management Representative I Utilization Management Representative I Location : This ... and analytical skills. Job Level: Non-Management Non-Exempt Workshift: Job Family: CUS > Care ...
The Utilization Management Representative I is responsible for coordinating cases for ... analytical skills. Please be advised that Elevance Health only accepts resumes for compensation ...
The Utilization Management Representative I is responsible for coordinating cases for ... analytical skills. Please be advised that Elevance Health only accepts resumes for compensation ...
Capacity Analyst
Greeneville, TN · On-site
Capacity Analyst GENERAL SUMMARY: The Capacity Analyst is responsible for analyzing, tracking, and ... Track capacity availability, utilization, efficiency, and throughput by asset, line, and department.
Capacity Analyst
Greeneville, TN · On-site
Capacity Analyst GENERAL SUMMARY: The Capacity Analyst is responsible for analyzing, tracking, and ... Track capacity availability, utilization, efficiency, and throughput by asset, line, and department.
The Utilization Management Representative I is responsible for coordinating cases for ... analytical skills. Please be advised that Elevance Health only accepts resumes for compensation ...
The Utilization Management Representative I is responsible for coordinating cases for ... analytical skills. Please be advised that Elevance Health only accepts resumes for compensation ...
Evaluate utilization management program effectiveness and recommend improvements, including needs analysis and planning. * Ensures provider satisfaction with utilization management program. * Ensure ...
Quick apply
Evaluate utilization management program effectiveness and recommend improvements, including needs analysis and planning. * Ensures provider satisfaction with utilization management program. * Ensure ...
Occupancy Planner
Nashville, TN · On-site +1
Conduct occupancy and utilization analyses to identify planning opportunities and recommend space solutions. * Present planning recommendations, utilization analyses, and portfolio insights to ...
New
Occupancy Planner
Nashville, TN · On-site +1
Conduct occupancy and utilization analyses to identify planning opportunities and recommend space solutions. * Present planning recommendations, utilization analyses, and portfolio insights to ...
New
Evaluate utilization management program effectiveness and recommend improvements, including needs analysis and planning. * Ensures provider satisfaction with utilization management program. * Ensure ...
Evaluate utilization management program effectiveness and recommend improvements, including needs analysis and planning. * Ensures provider satisfaction with utilization management program. * Ensure ...
Evaluate utilization management program effectiveness and recommend improvements, including needs analysis and planning. * Ensures provider satisfaction with utilization management program. * Ensure ...
Evaluate utilization management program effectiveness and recommend improvements, including needs analysis and planning. * Ensures provider satisfaction with utilization management program. * Ensure ...
Occupancy Planner
Nashville, TN · On-site +1
Conduct occupancy and utilization analyses to identify planning opportunities and recommend space solutions. * Present planning recommendations, utilization analyses, and portfolio insights to ...
New
Occupancy Planner
Nashville, TN · On-site +1
Conduct occupancy and utilization analyses to identify planning opportunities and recommend space solutions. * Present planning recommendations, utilization analyses, and portfolio insights to ...
New
Occupancy Planner
Nashville, TN · On-site +1
Conduct occupancy and utilization analyses to identify planning opportunities and recommend space solutions. * Present planning recommendations, utilization analyses, and portfolio insights to ...
New
Occupancy Planner
Nashville, TN · On-site +1
Conduct occupancy and utilization analyses to identify planning opportunities and recommend space solutions. * Present planning recommendations, utilization analyses, and portfolio insights to ...
New
Occupancy Planner
Nashville, TN · On-site +1
Conduct occupancy and utilization analyses to identify planning opportunities and recommend space solutions. * Present planning recommendations, utilization analyses, and portfolio insights to ...
New
Occupancy Planner
Nashville, TN · On-site +1
Conduct occupancy and utilization analyses to identify planning opportunities and recommend space solutions. * Present planning recommendations, utilization analyses, and portfolio insights to ...
New
Evaluate utilization management program effectiveness and recommend improvements, including needs analysis and planning. * Ensures provider satisfaction with utilization management program. * Ensure ...
Evaluate utilization management program effectiveness and recommend improvements, including needs analysis and planning. * Ensures provider satisfaction with utilization management program. * Ensure ...
Capacity Analyst
Greeneville, TN · On-site
... and utilization across key operations including printing, converting, and packaging. ESSENTIAL ... • Analyze available versus required capacity based on forecasted demand, production schedules ...
Capacity Analyst
Greeneville, TN · On-site
... and utilization across key operations including printing, converting, and packaging. ESSENTIAL ... • Analyze available versus required capacity based on forecasted demand, production schedules ...
Utilization Analyst information
What is the difference between Utilization Analyst vs Data Analyst?
| Aspect | Utilization Analyst | Data Analyst |
|---|---|---|
| Required Credentials | Bachelor's in healthcare, business, or related field; certifications like CPC or HCISPP | Bachelor's in statistics, computer science, or related field; certifications like CAP or Microsoft Certified Data Analyst |
| Work Environment | Healthcare facilities, insurance companies, or healthcare consulting firms | Various industries including finance, marketing, healthcare, and technology |
| Employer & Industry Usage | Used primarily in healthcare and insurance sectors to optimize resource utilization | Used across multiple industries to analyze data trends and support decision-making |
While both roles involve analyzing data, a Utilization Analyst focuses on healthcare resource management and efficiency, whereas a Data Analyst has a broader scope across industries, analyzing diverse data sets to inform strategic decisions.
What does a utilization analyst do?
A utilization analyst monitors and analyzes the use of resources, such as staff or equipment, to ensure efficiency and cost-effectiveness. They often use data analysis tools and reports to identify underutilized assets and recommend improvements to optimize resource allocation.
What are popular job titles related to Utilization Analyst jobs in Tennessee?
For Utilization Analyst jobs in Tennessee, the most frequently searched job titles are:
What job categories do people searching Utilization Analyst jobs in Tennessee look for?
The top searched job categories for Utilization Analyst jobs in Tennessee are:
What cities in Tennessee are hiring for Utilization Analyst jobs?
Cities in Tennessee with the most Utilization Analyst job openings:
Utilization Management Nurse
Nashville, TN • On-site
ArchWell Health •
Outpatient Health Care • 11 - 50 employees11 - 50 employees
8.0
Based on 20 frontline employees who took The Breakroom Quiz
3rd of 245 rated social care providers
Great coworkers
People enjoy working here
Good employer
Recommended by parents
Respectful managers
Full-time
Re-posted 18 days ago
Job description
Job Summary:
Reporting to the Director of Utilization Management, the Utilization Management Nurse is responsible for ensuring that patients receive appropriate, cost-effective care by reviewing and evaluating medical services, treatments, and procedures. This role identifies trends for opportunities to educate and collaborate with healthcare providers, patients, and specialists to optimize resource utilization and improve patient outcomes.
Duties/Responsibilities:
Required Skills/Abilities:
Education and Experience:
ArchWell Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to their race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other protected classification.
Reporting to the Director of Utilization Management, the Utilization Management Nurse is responsible for ensuring that patients receive appropriate, cost-effective care by reviewing and evaluating medical services, treatments, and procedures. This role identifies trends for opportunities to educate and collaborate with healthcare providers, patients, and specialists to optimize resource utilization and improve patient outcomes.
Duties/Responsibilities:
- Conducts prospective, concurrent, and retrospective utilization reviews for medical necessity to ensure treatment and services are appropriate and necessary by reviewing medical records and treatment plans.
- Works collaboratively with healthcare providers and Medical Directors to provide guidance on approvals or requests for health plan determination reviews as applicable utilizing CMS clinical guidelines and insurance policies.
- Maintains accurate and detailed records of reviews, interventions, and communications to ensure adherence to health plan requirements and organizational policies.
- Analyze utilization trends to ensure progress towards organizational goals
- Educates healthcare providers and patients regarding appropriate levels of care and service criteria and guidelines.
- Collaborates with Network and specialists to identify opportunities to educate on value-based care, resolve specialty gaps by markets, improve cost-effectiveness and coordination of care to meet patient needs.
Required Skills/Abilities:
- Strong knowledge of utilization management functions in value-based care, including data analysis, claims review, reimbursement practices, and medical records reviews.
- Thorough, in-depth knowledge of evidence-based practice, legal rules and regulations and best practices in healthcare
- Ability to effectively leverage business and organizational knowledge within and across functional areas
- Must possess a high degree of emotional intelligence and integrity, driven and focused work ethic
- Continuous desire to learn and embrace new methods; ability to adapt and be resilient.
- Self-starter with the ability to think creatively and work effectively
- Ability to build a relationship and work effectively with various seniorities and diverse populations.
- Excellent critical reasoning, decision-making, and problem-solving skills to make informed decisions and ensure effective resource utilization while maintaining quality patient care.
- Willingness and ability to travel, up to 20%
Education and Experience:
- AA/AS degree in Nursing required; BA/BS degree in Nursing (BSN) or Healthcare Administration preferred
- A valid, active Registered Nurse (RN) license in state(s) of employment required
- A minimum of 3 years', current direct utilization management required
- Work in an acute care facility, community-based clinic, public health department or specialization with the senior population preferred
- Proficient PC skills
- Fluency in Spanish or other languages spoken by people in the communities we serve is desirable, but not required
ArchWell Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to their race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other protected classification.
About ArchWell Health
Sourced by ZipRecruiter
At ArchWell Health, we help our members lead healthier lives through superior senior primary care and stronger patient-to-doctor relationships. You’ll find plenty of reasons to love being an ArchWell Health member. You’ll also discover that they add up to something huge—a healthier and happier you.
Industry
Outpatient health care
Company size
11 - 50 Employees
Headquarters location
Nashville, TN, US
Year founded
2020
Website
What ArchWell Health employees say
Pay
Benefits
Hours and flexibility
Workplace
Get the full story on Breakroom