- CVS Health (Frankfort, KY)
- …/benefit management program. **Required Qualifications** + Licensed independent behavioral health clinician with Kentucky state licensure (LCSW, LPCC, ... clinically appropriate treatment, evidence-based care and clinical practice guidelines for Behavioral Health and/or medical conditions based upon program focus.… more
- Humana (Frankfort, KY)
- …value-based care, quality metrics, population health , and disease or care management . The Behavioral Health Medical Director may develop procedures, ... part of our caring community and help us put health first** The Behavioral Health ...management , utilization management , case management , discharge planning and/or home health or… more
- Humana (Frankfort, KY)
- …providing clinical services + Experience in utilization management review and case management in a health plan setting + MUST HAVE ONE OF THE FOLLOWING ... part of our caring community and help us put health first** The Behavioral Health ...a focus on collaborative business relationships, value-based care, population health , or disease or care management *… more
- CVS Health (Frankfort, KY)
- … health care innovators. The Engagement Outreach Hub Care Management Associate supports comprehensive coordination of healthcare services through telephonic ... Bring your heart to CVS Health . Every one of us at CVS ...personal, convenient and affordable. **Position Summary** **Aetna's Medicaid Care Management Engagement Outreach Hub** is a _new_ initiative focused… more
- Evolent Health (Frankfort, KY)
- …Join Evolent for the mission. Stay for the culture. **What You'll Be Doing:** As a Behavioral Health Field Medical Director will be a key member of the ... utilization management team. We can offer you...utilization management team. We can offer you a meaningful way...Opportunities:** Evolent Health is looking for a Behavioral Health Medical Director to be a… more
- Highmark Health (Frankfort, KY)
- …for the patient, and then creates the case (data entry) in Highmark's utilization management system for clinical review. Ensures all accurate information is ... including verification of benefit eligibility. Build cases in the utilization management system. + Use knowledge of...0 - 1 year of experience working in the Health Insurance Industry **LICENSES AND CERTIFICATIONS** **Required** + None… more
- Catholic Health Initiatives (Lexington, KY)
- … working with Medicare/Medicaid and other federal guidelines or 2 years Utilization management in hospital setting. Also desirable, experience in discharge ... planning functions, and monitoring of quality of service throughout the case management process. Performs direct Interqual/M&R utilization review on all acute… more
- Highmark Health (Frankfort, KY)
- …:** **JOB SUMMARY** This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and ... (DO) **Substitutions** + None **Preferred** + Master's Degree in Business Administration/ Management or Public Health **EXPERIENCE** **Required** + 5 years… more
- Humana (Frankfort, KY)
- …and subpopulations. Areas of focus include Care Management , Quality Improvement, Utilization Management , Population Health , Social Determinants of ... Health , Pharmacy, Behavioral Health , Institutional Long-Term Services and Supports (LTSS), Home and...Organization (MCO) focusing on Medicaid clinical strategy and population health management strategy. **Alternatively** **,** 5+ years… more
- Highmark Health (Frankfort, KY)
- …and education or if necessary involve Special Investigation Unit or the Utilization Management area. **ESSENTIAL RESPONSIBILITIES** + Implement the pre-payment ... data to assure appropriate level of payment and resource utilization . It is also used to identify issues which...measurable outcomes. Will monitor and analyze the delivery of health care services in accordance with claims submitted, and… more
- Highmark Health (Frankfort, KY)
- …(NCQA), Utilization Review Accreditation Committee (URAC), Pennsylvania Department of Health , Department of Labor, the Center for Medicare and Medicaid Services ... review and make determinations regarding physician reviewer assignments for medical management decisions. Cases requiring physician review are provider and member… more
- Highmark Health (Frankfort, KY)
- …resource efficiency. + Proposes ideas, designs, and solutions to lead engineers and management to further cloud service utilization and optimization. + Develops ... **Company :** Highmark Health **Job Description :** **JOB SUMMARY** This job...of action. + Level 3 Incident, problem and change management as it pertains to the responsibilities of the… more
- Highmark Health (Frankfort, KY)
- …that the system architecture balances functional, service quality and systems management requirements. + Use appropriate tools, including models of components and ... all levels of organization. + Manage expectations of customers, partners and management . + Participate in customer walkthroughs and plans; design and technical… more
- Highmark Health (Frankfort, KY)
- …actions (promotions, hiring, terminations, etc.) Develops talent, Addresses resource management , cultivates capabilities of staff, planning and coordination of work, ... in first-line resolution of complex technical problems 2. Provides Staff Management oversight * Hires, promotes, separates or makes recommendations regarding same… more
- Highmark Health (Frankfort, KY)
- **Company :** Highmark Health **Job Description :** **JOB SUMMARY** This job is a strong advocate of cloud technology and engineering support necessary to drive the ... to senior or lead engineers to further cloud service utilization and optimization. + Develops automation scripts and other...of action. + Level 2 Incident, problem and change management as it pertains to the responsibilities of the… more
- Molina Healthcare (Georgetown, KY)
- …Plan, NCQA, CMS and State Medicaid entities. **Job Duties** + Oversees Utilization Management , Claims, Organizational Credentialing, and Crisis Call Center ... + Lead external collaborative with other agencies in providing oversight of Behavioral Health Administrative Service Organization for monitoring and auditing of… more
- Molina Healthcare (Georgetown, KY)
- …(RN) Registered Nurse with previous experience in Hospital Acute Care, Concurrent Review/ Utilization Review / Utilization Management and knowledge of ... facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long term care, for members with high need… more
- Guardian Life (Frankfort, KY)
- …attitude. You can collaborate with stakeholders to provide effective case management within the boundaries of contractual definitions. **You will:** + Assess ... aptitudes, work experience, restrictions and limitations, educational background, and behavioral /motivational factors to determine viability of and probability of… more
- UMB Bank (Frankfort, KY)
- …modeling and data analytics with emphasis on credit scoring, credit risk, behavioral models, loan loss and general purpose risk/profitability models. Specific duties ... and provide recommendations to support the execution of portfolio risk management strategies. Forecast trends, monitor statistical and machine learning models and… more