- Humana (Frankfort, KY)
- **Become a part of our caring community and help us put health first** The Utilization Management Registered Nurse 2 utilizes clinical nursing skills to ... independent determination of the appropriate courses of action. The Utilization Management Registered Nurse...skills to make an impact** **Required Qualifications** + **Licensed Registered Nurse ( RN )** in the… more
- Molina Healthcare (Lexington, KY)
- …Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG ... guidelines. **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). **WORK SCHEDULE: Mon - Fri / Sun… more
- Fresenius Medical Center (Shelbyville, KY)
- …auditing activities. + Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. + Manages clinic ... financials including efficient utilization of supplies or equipment and regular profits and...of supplies or equipment and regular profits and loss review . + Responsible for all required network reporting and… more
- Highmark Health (Frankfort, KY)
- …and Sunday required in addition to 3 weekdays** This job implements effective utilization management strategies including: review of appropriateness of ... and offers interventions and/or alternatives. **ESSENTIAL RESPONSIBILITIES** + Implement care management review processes that are consistent with established… more
- Highmark Health (Frankfort, KY)
- …Remote - Part Time - Weekends Required.** This job implements the effective utilization management strategies including: review of appropriateness of health ... and offers interventions and/or alternatives. **ESSENTIAL RESPONSIBILITIES:** + Implement care management review processes that are consistent with established… more
- Centene Corporation (Frankfort, KY)
- …Family Therapist (LMFT) required or + Licensed Mental Health Professional (LMHP) required or + RN - Registered Nurse - State Licensure and/or Compact State ... and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and… more
- CVS Health (Frankfort, KY)
- …Health clinician with Kentucky state licensure (LCSW, LPCC, LMFT, LPAT, LP) or a Registered Nurse ( RN ) with active current and unrestricted Kentucky state ... and affordable. **Position Summary** This is a fully remote Utilization Review Clinical Consultant. **MUST RESIDE IN...Health licensure (LCSW, LPCC, LMFT, LPAT, LP) or a Registered Nurse ( RN ) with unrestricted… more
- LifePoint Health (Versailles, KY)
- …and fosters an environment that encourages professional growth. Initiates weekend case management , Utilization review screening, assists with D/C planning ... Requirements Minimum EducationX Associate's degree - Required An Active RN License with KBN or a Compact RN...- within 60 days of hire and renewed annuallyTrauma Nurse Core Course (TNCC) - PreferredENPC - preferredNRP -… more
- Humana (Frankfort, KY)
- …Family Therapist **(LMFT)** , Licensed Professional Counselor **(LPC)** , Psychologist **(PhD)** , Registered Nurse **( RN )** or other professional license. + ... us put health first** Humana Healthy Horizons in Kentucky is seeking a Utilization Management Behavioral Health Professional 2 who utilizes behavioral health… more
- Molina Healthcare (Lexington, KY)
- …and production levels are maintained + Performs monthly auditing of registered nurse and other clinical functions in Utilization Management (UM), Case ... Management (CM), Member Assessment Team (MAT), Health Management (HM), and/or Disease Management (DM) and...them.. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse ( RN ) Program and… more
- CenterWell (Lexington, KY)
- …license, auto insurance and reliable transportation. + Two years as a Registered Nurse with at least one-year of management experience in a home care, ... clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the...School of Nursing. + Current state license as a Registered Nurse . + Proof of current CPR.… more
- Molina Healthcare (Lexington, KY)
- …Medical, or ER unit. **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). To all current Molina ... acute care/medical experience. **Required License, Certification, Association** Active, unrestricted State Registered Nursing ( RN ) license in good standing. Must… more
- Molina Healthcare (Lexington, KY)
- … Registered Nursing ( RN ) license in good standing. + Utilization Management Certification (CPHM) Certified Professional in Health Care Quality (CPHQ), ... and results across Molina Health Plans & Segments. **KNOWLEDGE/SKILLS/ABILITIES** + Review existing case management standards and processes and establishes… more
- Catholic Health Initiatives (Lexington, KY)
- …emphasis will be on care coordination, communication and collaboration with utilization management , nursing, physicians, ancillary departments, insurers and post ... their practice. 13. Performs other duties as assigned, including utilization review as necessary. _The job summary...multiple stakeholders + Professional communication skills. + Understand how utilization management and case management … more
- Guardian Life (Frankfort, KY)
- …services. Act as a liaison between all parties required in case management to facilitate collaboration toward RTW goals. Utilization of independent ... **Position Summary** The RN Clinical Consultant serves as a clinical resource...issues, when possible, to enhance the customer experience. **Activity** Review and assess claimant subjective reports and objective medical… more
- Molina Healthcare (Lexington, KY)
- … Registered Nursing ( RN ) license in good standing. + Utilization Management Certification (CPHM) Certified Professional in Health Care Quality (CPHQ), ... _Candidates must possess a current RN license, as well as a Bachelor's Degree_...Integrated DSNP Medicare and Medicaid model that ensures case management and utilization management work… more
- LifePoint Health (Georgetown, KY)
- …discharge follow up calls and coordinates care for identified needs. - Performs utilization review of patients admitted overnight to ensure appropriate inpatient ... EducationAssociate's Degree Nursing (ADN) RequiredBachelor's Degree Nursing (BSN) Preferred Required SkillsLicenses: Registered Nurse in State of KY Three years… more