- Humana (Frankfort, KY)
- …help us put health first** Humana Healthy Horizons in Kentucky is seeking a Utilization Management Behavioral Health Professional 2 who utilizes ... and communication of medical services and/or benefit administration determinations. The Utilization Management Behavioral Health Professional… more
- CVS Health (Frankfort, KY)
- …meetings when requested * Oversight and implementation of the utilization management program for behavioral health services, including preventing ... health plan. They will have key roles in utilization management and case management ...development of clinical practice standards, policies, and procedures * Behavioral health care management performance… more
- Centene Corporation (Frankfort, KY)
- …in accordance with regulatory guidelines and criteria + Performs concurrent review of behavioral health (BH) inpatient to determine overall health of ... licensure as outlined by the applicable state required. Master's degree for behavioral health clinicians required. Clinical knowledge and ability to review… more
- Humana (Frankfort, KY)
- …such as provider relations, claims submission and payment, utilization management processes, behavioral health processes, and dispute resolution. ... part of our caring community and help us put health first** Humana Healthy Horizons is seeking a Senior...educational material, or trainings. + 3+ years of project management experience with mid-size projects. + 2+ years of… more
- CVS Health (Frankfort, KY)
- …+ Managed care/ utilization review experience preferred + Experience in a behavioral health inpatient setting + Ability to multitask, prioritize and ... clinically appropriate treatment, evidence based care and clinical practice guidelines for Behavioral Health and/or medical conditions based upon program focus.… more
- Highmark Health (Frankfort, KY)
- …Time - Weekends Required.** This job implements the effective utilization management strategies including: review of appropriateness of health care services, ... utilization , identification of opportunities for referral to a Health Coach/case management , and identification and resolution...years of post licensure experience in a combination of Behavioral Health Clinical, Case Management … more
- CVS Health (Frankfort, KY)
- …outreaches and computer documentation. + Assist members with locating community based behavioral health resources. **Required Qualifications** + 3+ years of ... direct clinical practice experience + An active and unrestricted clinical behavioral health license in state of residence is required (ex: LPC, LCSW, LMFT, LPCC,… more
- CVS Health (Frankfort, KY)
- …for Aetna. Health Services strategies, policies, and programs are comprised of utilization management , quality management , network management and ... on interventions to improve outcomes. **Required Qualifications** * 2 years' experience in behavioral health , social services, or human services field. * 1 year… more
- Highmark Health (Frankfort, KY)
- …in addition to 3 weekdays** This job implements effective utilization management strategies including: review of appropriateness of health care services, ... utilization , identification of opportunities for referral to a Health Coach/case management , and identification and resolution...position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of… 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
- Highmark Health (Frankfort, KY)
- …, physician practice management or clinical operations, ancillary provider management or clinical operations, and/or health insurance) with significant ... knowledge of and experience with various care delivery models + Experience in health plan provider network performance management , care/case management ,… more
- Molina Healthcare (Georgetown, KY)
- …State Registered Nursing (RN) license in good standing. + Utilization Management Certification (CPHM) Certified Professional in Health Care Quality (CPHQ), ... delivery of care across the continuum. This includes physical health and behavioral health for...oversight to the segment clinical teams - specifically care management and utilization management -… more
- Highmark Health (Frankfort, KY)
- …to deliver financial results to the Enterprise. **ESSENTIAL RESPONSIBILITIES** + Perform management responsibilities to include, but are not limited to: involved in ... termination decisions, coaching and development, rewards and recognition, performance management and staff productivity.Plan, organize, staff, direct and control the… 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
- Molina Healthcare (Lexington, KY)
- …facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long term care, for members with high need ... Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG guidelines.… more
- Molina Healthcare (Lexington, KY)
- …nurse and other clinical functions in Utilization Management (UM), Case Management (CM), Member Assessment Team (MAT), Health Management (HM), and/or ... management , disease management , managed care or medical or behavioral health settings. + One year of auditing/ clinical review experience. + More than… more
- Humana (Frankfort, KY)
- …innovative **Value Based Program** models for range of provider types, such as behavioral health , maternity, specialists, and social determinants of health , ... **Become a part of our caring community and help us put health first** The Value-Based Programs Lead supports successful value-based provider relationships with a… more
- Molina Healthcare (Lexington, KY)
- …plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care, for members with high need potential. ... Provides clerical, data entry and/or telephone support for the Utilization Management team. + Manages the workflow...approvals and denials and other integrated Molina programs including Behavioral Health and Long-Term Care. + Enters… more
- NASCO (Frankfort, KY)
- …wide (or Plan Enterprise) implementation of product capabilities related to data management and membership or billing processing subsystems. This role aids Plan ... system and assists in defining the development standards, programming, troubleshooting and management of problems affecting IT software to help sustain the highest… more
- Humana (Frankfort, KY)
- …opportunities which may support Member Engagement, Clinical Performance, Provider Engagement, Behavioral Health and Pharmacy. This position reports to Quality ... part of our caring community and help us put health first** The Senior Data and Reporting Professional generates...role is to develop organized analytics, reports and data management to support the market's Quality team within the… more