- Molina Healthcare (Georgetown, KY)
- …including 3 or more years in one or more of the following areas: utilization management , case management , care transition and/or disease management ... + Experienced **Product** Owner - Managing requirements, testing and implementation for Utilization Management platforms required; Pega UM preferred (5+yrs) +… more
- Fresenius Medical Center (Lexington, KY)
- **About this role:** As a Clinical Manager with Fresenius Medical Care, you will ensure that quality patient care is delivered while maintaining clinical operations. ... leading your business, and advanced leadership. As a Clinical Manager , you may advance your career into an Area...Disease (ICD) coding. + Manages clinic financials including efficient utilization of supplies or equipment and regular profits and… more
- Molina Healthcare (Georgetown, KY)
- …Chief Medical Officer on denial decisions. + Resolves escalated complaints regarding Utilization Management and Long-Term Services & Supports issues. + ... be required. + Serves as a clinical resource for Utilization Management , Chief Medical Officer, Physicians, and...Coder + Certified Medical Audit Specialist + Certified Case Manager + Certified Professional Healthcare Management +… more
- Molina Healthcare (Georgetown, KY)
- …of payment decisions. + Serves as a clinical resource for Utilization Management , Chief Medical Officers, Physicians, and Member/Provider Inquiries/Appeals. ... **REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:** + Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical… more
- Molina Healthcare (Georgetown, KY)
- … Nurse with previous experience in Hospital Acute Care, Concurrent Review/ Utilization Review / Utilization Management and knowledge of Interqual ... Medical, or ER unit. **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). To all current Molina… more
- Highmark Health (Frankfort, KY)
- …Inc. **Job Description :** **JOB SUMMARY** This job implements the effective utilization management strategies including: review of appropriateness of health ... Management + Experience in a clinical setting **Preferred** + Certification in utilization management or a related field + Experience in UM/CM/QA/Managed Care… more
- Catholic Health Initiatives (Lexington, KY)
- …system following standard work ensuring accuracy. + Reviews all schedules and alerts nurse manager to critical staffing needs. + Validates current census and ... running reports in the schedule software. Prepare data for management to present to stakeholders. The Coordinator is also...works to resolve customer conflicts and complaints. + Keep nurse managers informed of unfilled shifts and call-ins. +… more