Franklin, Tennessee, United States · Remote OK
American Health Plans, a division of Franklin, Tennessee-based American Health Partners Inc. owns and operates Institutional Special Needs Plans (I-SNPs) for seniors who reside in long-term care facilities. In partnershi…
Skills: Utilization Management, Medical Necessity Assessment, Interqual, MCG, Medicare Regulations
Murfreesboro, Tennessee, United States · On-site
$12/hr–$13/hr
DUNKIN' CREW MEMBERS Wanna make a LATTE’ DOUGH? At Bluemont, our vision is simple: everyone is better off for being here. By caring for our team, we empower them to care for our guests—living out Respect, Int…
Skills: Customer Service, Teamwork, Reliability, Punctuality, Food Preparation
Chattanooga, Tennessee, United States · On-site
Reports to Store Manager: As a Store Lead, you will partner with your Store Manager to support store team members to achieve sales performance expectations through active coaching, development of a team selling environme…
Skills: Retail Management, Sales Performance, Team Coaching, Operational Excellence, Customer Experience
Madisonville, Tennessee, United States · On-site
$11/hr–$12/hr
DUNKIN' CREW MEMBERS Wanna make a LATTE’ DOUGH? At Bluemont, our vision is simple: everyone is better off for being here. By caring for our team, we empower them to care for our guests—living out Respect, Int…
Skills: Customer Service, Teamwork, Reliability, Punctuality, Food Preparation
Morristown, Tennessee, United States · On-site
$11/hr–$12/hr
DUNKIN' CREW MEMBERS Wanna make a LATTE’ DOUGH? At Bluemont, our vision is simple: everyone is better off for being here. By caring for our team, we empower them to care for our guests—living out Respect, Int…
Skills: Customer Service, Teamwork, Reliability, Punctuality, Food Preparation
Knoxville, Tennessee, United States · On-site
$12/hr–$13/hr
DUNKIN' CREW MEMBERS Wanna make a LATTE’ DOUGH? At Bluemont, our vision is simple: everyone is better off for being here. By caring for our team, we empower them to care for our guests—living out Respect, Int…
Skills: Customer Service, Teamwork, Reliability, Punctuality, Communication
Knoxville, Tennessee, United States · On-site
$12/hr–$13/hr
DUNKIN' CREW MEMBERS Wanna make a LATTE’ DOUGH? At Bluemont, our vision is simple: everyone is better off for being here. By caring for our team, we empower them to care for our guests—living out Respect, Int…
Skills: Customer Service, Teamwork, Reliability, Punctuality, Food Preparation
Nashville, Tennessee, United States · On-site
Join our team and live the Ollie-tude!: (Ollie’s Core Values) BE A TEAM PLAYER- Associates are expected to be supportive and work together. BE CARING- How do I treat others with courtesy, dignity, and respect? BE V…
Skills: Merchandising, Retail sales, Team leadership, Inventory management, Customer service
Chattanooga, Tennessee, United States · On-site
We are hiring Housekeepers! Are you ready to begin your journey with a company that believes in and supports career advancement opportunities for its associates? If so, we may have the perfect position for you! Responsib…
Skills: Housekeeping, Hospitality, Attention To Detail, Organizational Skills, Teamwork
Morristown, Tennessee, United States · On-site
$11/hr–$12/hr
DUNKIN' CREW MEMBERS Wanna make a LATTE’ DOUGH? At Bluemont, our vision is simple: everyone is better off for being here. By caring for our team, we empower them to care for our guests—living out Respect, Int…
Skills: Customer Service, Teamwork, Reliability, Punctuality, Food Preparation
Hendersonville, Tennessee, United States · On-site
We consider applications for this position on an ongoing basis. OVERVIEW Experience a place of energy, passion, and excitement. A place where the joy of discovery and uncommon artistry blend to create exhilarating buying…
Skills: Guest Service, Retail Sales, Product Knowledge, Cashiering, Makeup Application
Cordova, Tennessee, United States · On-site
Work Where You Matter At Dollar General, our mission is Serving Others! We value each and every one of our employees. Whether you are looking to launch a new career in one of our many convenient Store locations, Distribu…
Skills: Employee Supervision, Inventory Management, Merchandising, Customer Service Leadership, Cash Handling
Jefferson City, Tennessee, United States · On-site
Job Summary The ER Registrar is responsible for managing patient intake and registration processes in the Emergency Department. This role gathers and verifies personal, insurance, and medical information, ensures accurac…
Skills: Patient Registration, Insurance Verification, Customer Service, Medical Terminology, Electronic Health Records
Nashville, Tennessee, United States · On-site
Why We're Here We believe heartfelt, human connections make people's lives better. Especially the people who work here. Our founder, Bill Kimpton rebelled against impersonal, generic hospitality that makes people feel di…
Skills: Guest Service, Staff Scheduling, Employee Training, Performance Coaching, Budget Management
Knoxville, Tennessee, United States · On-site
In a UTPD communications position you are in a role responsible for receiving incoming calls, logging information, and coordinating the dispatch of appropriate personnel or services to address emergency or non-emergency …
Skills: Multi-tasking, Communication Skills, Customer Service, Problem Solving, Active Listening
Nashville, Tennessee, United States · On-site
Description - External Reports to Store Manager: As a Store Lead, you will partner with your Store Manager to support store team members to achieve sales performance expectations through active coaching, development of a…
Skills: Retail Management, Sales Performance, Team Coaching, Operational Excellence, Customer Experience
Memphis, Tennessee, United States · On-site
$12/hr–$13/hr
Now Hiring: Bar Back We are seeking a reliable and hardworking Bar Back to support our team and ensure smooth, efficient bar operations. You will play a vital role in maintaining a clean environment and guaranteeing our …
Skills: Customer Service, Teamwork, Stock Management, Sanitation, Organization
Memphis, Tennessee, United States · On-site
Position Overview The Food Runner is the vital link between our culinary team and our guests. This role is crucial for maintaining the seamless, high-speed flow of service, ensuring every dish is delivered promptly and a…
Skills: Food Delivery, Guest Relations, Multitasking, Communication, Quality Control
Chattanooga, Tennessee, United States · On-site
Location: Onsite listed in the job posting. Schedule: Mon-Fri 9:00am - 4:00pm Summary If you’re a natural leader and want to lead a team at a strong company with exceptional support, then you’ll want to be on…
Skills: Business Development, Client Relationship Management, Team Leadership, Sales, Customer Service
Memphis, Tennessee, United States · Hybrid
Datavant is the data collaboration platform trusted for healthcare. Guided by our mission to make the world’s health data secure, accessible and actionable, we provide critical data solutions for organizations across the…
Skills: Release Of Information, HIPAA Compliance, Medical Terminology, Data Entry, Microsoft Word
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The Utilization Review Nurse assesses the medical necessity and quality of healthcare services through pre-service, concurrent, and retrospective reviews. They provide clinical support to ensure members receive appropriate medical services in compliance with regulatory guidelines.
Requires a current, active, and unrestricted Registered Nurse (RN) license and at least one year of utilization management experience using Interqual or MCG. Candidates should have strong knowledge of Medicare regulations, medical coding, and clinical certification principles.
American Health Plans, a division of Franklin, Tennessee-based American Health Partners Inc. owns and operates Institutional Special Needs Plans (I-SNPs) for seniors who reside in long-term care facilities. In partnership with nursing home operators, these Medicare Advantage plans manage medical risk by improving patient care to reduce emergency room visits and avoidable hospitalizations. This division currently operates in Tennessee, Georgia, Missouri, Kansas, Oklahoma, Utah, Texas, Mississippi, Iowa, Idaho, Louisiana, and Indiana with planned expansion into other states in 2025. For more information, visit AmHealthPlans.com.
If you would like to be part of a collaborative, supportive and caring team, we look forward to receiving your application!
JOB SUMMARY:
The Utilization Review Nurse is to assess the medical necessity and quality of healthcare services by conducting pre-service, concurrent, and retrospective utilization management reviews. The primary role of the Utilization Management (UM) Nurse is to provide clinical support to the Clinical Services Department and Medical Director to assure that members receive all appropriate medical services in compliance with medical and regulatory guidelines.
To perform this job, an individual must accomplish each essential function satisfactorily, with or without a reasonable accommodation.
• Assess the medical necessity, quality of care, level of care and appropriateness of health care services for plan members
• Identify placement settings that offer the lowest level of restriction and greatest level of autonomy for the members based upon medical necessity
• Conduct outreach to requesting providers which can include specialty physicians, ancillary providers and institutions to gather the appropriate/necessary clinical data
• Apply clinical review criteria, guidelines, and screens in determining the medical necessity of health care services against the clinical data provided
• Certify cases that meet clinical review criteria, guidelines and/or screens
• Consult with physician when reviews do not meet clinical review criteria, guidelines, and screens
• Refer cases to other professionals internally, including case management and medical consultation when indicated
• Adhere to accreditation, contractual and regulatory timeframes in performing all utilization management review processes
• Ensure that the Director of Medical Management or designee is made aware of any potential risk management issues in a timely manner
• Other duties as assigned
JOB REQUIREMENTS:
• Maintain privacy and confidentiality of records, conditions, and other information relating to residents, employees and facility
• Encourage an atmosphere of optimism, warmth and interest in patients’ personal and health care needs
• Develop and maintain collaborative relationships with providers and educate on levels of care
• Ensure the integrity and high quality of utilization management services
• Self-motivated
• Ability to work independently and as part of a team
• Able to work congenially with a wide variety of individuals
• Maintain the highest level of confidentiality and professionalism at all times
• Strong oral and written communications skills, including active listening
• Proficient in navigating through multiple computer applications
• Positive, engaging customer service skills
• Critical thinking and decision-making skills
• Successful completion of required training
• Handle multiple priorities effectively
• Independent discretion/decision making
• Make decisions under pressure
REQUIRED QUALIFICATIONS:
• Experience:
o At least 1 year experience in utilization management with a health plan or hospital-based UM department with use of Interqual or MCG
o Prefer clinical experience
o Broad knowledge of Medicare regulations and guidance
o Trained in clinical certification, utilization management, URAC and NCQA principles, policies, and procedures
o Excellent customer service experience
o Strong knowledge of medical terminology and CPT, ICD-10, and HCPCS codes
o Proven ability to problem-solve and make solid decisions
• License/Certification:
o Current Certified Case Manager (CCM) credential is a plus
o Current, active and unrestricted Registered Nurse (RN) license
This Organization is an equal opportunity employer. We do not discriminate based on race, color, religion, sex, handicap, disability, age, marital status, sexual orientation, national origin, veteran status, or any other characteristic(s) protected by federal, state, and local laws. This Organization will make reasonable accommodations for qualified individuals with disabilities should a request for an accommodation be made. A key part of this policy is to provide equal employment opportunity regarding all terms and conditions of employment and in all aspects of a person's relationship with the Organization including recruitment, hiring, promotions, upgrading positions, conditions of employment, compensation, training, benefits, transfers, discipline, and termination of employment.
Senior care is the heart of our business.
Our Experience is Second to None. TruHealth’s nurse practitioners (NPs) and physician assistants (PAs) are contracted to work in skilled nursing facilities in multiple states, including Tennessee, Kansas, Oklahoma and others. Our providers expand patients’ access to care and may act as care managers for specialized Medicare Advantage health plans serving residents in long-term care communities.
Offices: 201 Jordan Rd, Franklin, Tennessee 37067, US
Based on 1259 listings with disclosed salaries, most customer service & support jobs in Tennessee pay between $45k–$105k per year. Individual offers vary with seniority, company size, and specialization.
There are currently 17,357 open customer service & support positions in Tennessee listed on Clera. New openings are added daily as companies post roles.
Companies currently hiring include Domino's, Lowe's Companies, Inc., CVS Health, AutoZone, Tractor Supply Company, among others. Browse the listings above to see every active employer.
Yes — 945 of the 17357 open customer service & support positions offer remote or hybrid work (506 remote, 439 hybrid).
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