Case Management Analyst
Location
Nashville, Tennessee
Job Type
Full-time
Category
other-general
Posted
May 15, 2026
Case Management Analyst (UM)
This position is responsible for pre-authorization reviews in accordance with the medical contract and regulations, medical criteria, utilization review, and quality of care.
JOB REQUIREMENTS:
1. LPN with valid, current, unrestricted clinical license in the state of operations.
2. Clinical experience in Home Health and DME
3. Utilization review or utilization management experience
4. Clinic Review for medical necessity based on specific needs of the patient and evidence supporting it and appropriateness of services.
5. Clinical Reviewer with relevant expertise and Medicare UM experiences responsible for making determinations utilizing the correct criteria and consider the clinical information provided.
6. Customer service oriented to assist internal/external customers.
7. Verbal and written communication skills.
8. Interpersonal skills and ability to be a team player.
This position is responsible for pre-authorization reviews in accordance with the medical contract and regulations, medical criteria, utilization review, and quality of care.
JOB REQUIREMENTS:
1. LPN with valid, current, unrestricted clinical license in the state of operations.
2. Clinical experience in Home Health and DME
3. Utilization review or utilization management experience
4. Clinic Review for medical necessity based on specific needs of the patient and evidence supporting it and appropriateness of services.
5. Clinical Reviewer with relevant expertise and Medicare UM experiences responsible for making determinations utilizing the correct criteria and consider the clinical information provided.
6. Customer service oriented to assist internal/external customers.
7. Verbal and written communication skills.
8. Interpersonal skills and ability to be a team player.