- 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
- 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
- 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)
- …Experience and/or proficiency with Disability Management (STD/LTD) knowledge, Workers Compensation, Utilization Review and/or nurse case management ... 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)
- …of payment decisions. + Serves as a clinical resource for Utilization Management , Chief Medical Officers, Physicians, and Member/Provider Inquiries/Appeals. ... SKILLS & ABILITIES:** + Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years… 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...the specific programs supported by the plan such as Utilization Review , Medical Claims Review ,… more
- Prime Therapeutics (Frankfort, KY)
- …of post-degree clinical experience. + Experience in managed care, specialty drugs, care management and utilization review . + Meets Magellan Credentialing ... and drives every decision we make. **Job Posting Title** Infusion Referral Nurse - REMOTE **Job Description Summary** Under supervision, is responsible for performing… more
- Fresenius Medical Center (Lexington, 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
- Molina Healthcare (Georgetown, KY)
- …with previous experience in Hospital Acute Care, Concurrent Review / Utilization Review / Utilization Management and knowledge of Interqual / MCG ... Medical, or ER unit. **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). To all current Molina… 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 & ... Great Place to Work(R) Most Loved Workplace(R) Forbes Best-in-State Employer RN Bill Review **PRIMARY PURPOSE** **:** To review hospital and professional medical… 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
- Highmark Health (Frankfort, KY)
- …Inc. **Job Description :** **JOB SUMMARY** This job implements the 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
- 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. +...staffing and prepares tentative staffing for clinical contact to review and approve. + Follows escalation procedures for day-… more
- Catholic Health Initiatives (Lexington, KY)
- …of new Epic functionality as assigned including the following responsibilities: a. Review of the functionality to determine scope and resources required b. Develop ... schedule e. Identify and coordinate communication needs 2. Provides oversight and management of all assigned projects from initial kick-off through conclusion of… 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 ... Care (Physical Training) - within 60 days of hire and renewed annuallyTrauma Nurse Core Course (TNCC) - PreferredENPC - preferredNRP - preferredNIHSS - required… more