- Humana (Frankfort, KY)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- Humana (Frankfort, KY)
- …documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are ... a part of our caring community and help us put health first** The Utilization Management Registered Nurse 2 utilizes clinical nursing skills to support the… more
- Conviva (Frankfort, KY)
- …+ Prior clinical experience, managed care experience, Home Health, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability ... Orthopedic procedures + Compact License preferred + Previous experience in utilization management within Insurance industry + Previous Medicare… more
- Lincoln Financial Group (Frankfort, KY)
- …and/or proficiency with Disability Management (STD/LTD) knowledge, Workers Compensation, Utilization Review and/or nurse case management preferred skills ... Role at a Glance** We are excited to bring on a highly motivated Nurse Disability Consultant to our clinical organization. This position will be responsible for… more
- 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
- Veterans Affairs, Veterans Health Administration (Lexington, KY)
- …They are responsible for the provision of continuity of care, access, utilization management , clinical guideline implementation and monitoring and performance ... through the continuum of care, patient and family education, patient self- management after discharge, and supporting factors that impact customer satisfaction.… more
- Molina Healthcare (Georgetown, KY)
- …Chief Medical Officer on denial decisions. + Resolves escalated complaints regarding Utilization Management and Long-Term Services & Supports issues. + ... as may be required. + Serves as a clinical resource for Utilization Management , Chief Medical Officer, Physicians, and Member/Provider Inquiries/Appeals. +… more
- Prime Therapeutics (Frankfort, KY)
- …post-degree clinical experience. + Experience in managed care, specialty drugs, care management and utilization review. + Meets Magellan Credentialing criteria. ... and drives every decision we make. **Job Posting Title** Infusion Referral Nurse - REMOTE **Job Description Summary** Under supervision, is responsible for performing… more
- Intermountain Health (Frankfort, KY)
- …cost-effective outcomes. Provides focused support to various areas such as utilization management , emergency department, acute, ambulatory and specialty care. ... in examining patterns of health care needs, decisions, lifestyle choices, and utilization of resources that affect their health. + Advocates, educates and coaches… 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. ... ABILITIES:** + Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review. + Minimum two years of experience in… more
- Fresenius Medical Center (Lexington, KY)
- …Classification of Disease (ICD) coding. + Manages clinic financials including efficient utilization of supplies or equipment and regular profits and loss review. + ... + Preferred but not required: + 3+ years supervisory or project/program management experience. + Med/surg or ICU/CCU experience. **PHYSICAL DEMANDS AND WORKING… more
- Humana (Frankfort, KY)
- …with mandated and corporate policies regarding other departmental areas such as medical management , utilization management , population health and quality. + ... Humana Healthy Horizons in Virginia is seeking an Associate Director, Care Management (LTSS/ABD) who will lead teams of healthcare professionals responsible for care… more
- Highmark Health (Frankfort, KY)
- …Inc. **Job Description :** **JOB SUMMARY** This job implements the effective utilization management strategies including: review of appropriateness of health ... Experience in a clinical setting **Preferred** + Certification in utilization management or a related field +...Family Therapist (LMFT) + Licensed Behavior Specialist + Registered Nurse . **Preferred** + None **SKILLS** + Working knowledge of… more
- J&J Family of Companies (Lexington, KY)
- …inclusion. Proud to be an equal opportunity employer. Advanced Practice Providers ( Nurse Practitioners /Physician Assistants) are a growing and critical segment of ... disease state and product education, and to support HCPs in appropriate utilization of JJIM access and fulfilment resources. The APP-Ambassador will compliantly… 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
- Catholic Health Initiatives (Lexington, KY)
- …collecting data and running reports in the schedule software. Prepare data for management to present to stakeholders. The Coordinator is also responsible for time ... works to resolve customer conflicts and complaints. + Keep nurse managers informed of unfilled shifts and call-ins. +...and deployment. + Performs other duties as assigned. **Information Management :** + Utilizes the staffing matrix as a guideline… more
- Catholic Health Initiatives (Lexington, KY)
- …schedule e. Identify and coordinate communication needs 2. Provides oversight and management of all assigned projects from initial kick-off through conclusion of ... to serve as resource for Informatics. 9. Other duties as assigned by management . 10. Rounds in clinical areas as assigned. Responsible for appropriate utilization… more
- Sedgwick (Frankfort, KY)
- …and consult review; and two (2) years of experience in daily application of nurse auditing, utilization review and bill review. **Skills & Knowledge** + ... providers including complex hospital, surgical, high level evaluation and management codes and/or technical bills. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** +… 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 and ... Care (Physical Training) - within 60 days of hire and renewed annuallyTrauma Nurse Core Course (TNCC) - PreferredENPC - preferredNRP - preferredNIHSS - required… more
- Molina Healthcare (Georgetown, KY)
- …to work a schedule using Pacific time zone. Previous experience working in utilization management for another MCO is preferred. This position is fully ... meetings. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse (RN). **Required Experience** 1-3 years of hospital or medical… more