- Cognizant (Frankfort, KY)
- …you need to have to be considered** + Educational background - Registered Nurse (RN) + 2-3 years combined clinical and/or utilization management ... Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact...care revenue cycle or clinic operations + Experience in utilization management to include Clinical Appeals and… more
- CVS Health (Frankfort, KY)
- …health clinician with Kentucky state licensure (LCSW, LPCC, LMFT, LPAT) or a Registered Nurse (RN) with active current and unrestricted Kentucky state license ... every day. **Position Summary** This is a fully **remote** Utilization Review Clinical Consultant. **Must reside in...of an Associate's in Nursing or Diploma RN for Registered Nurses **Anticipated Weekly Hours** 40 **Time Type** Full… 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 ... independent determination of the appropriate courses of action. The Utilization Management Nurse 2 uses clinical...skills to make an impact** **Required Qualifications** + **Licensed Registered Nurse (RN)** in the (appropriate state)… more
- Fresenius Medical Center (Georgetown, KY)
- …requirements. Ensure provision of quality patient care while maintaining cost-effective clinical operations in accordance with all legal, compliance, and regulatory ... FMCNA Compliance Program, and FMS patient care and administrative policies as the clinical leader, has the authority to make daily decisions to ensure continuity of… more
- Molina Healthcare (Lexington, KY)
- …health, pharmacy, etc.), or equivalent combination of relevant education and experience. * Registered Nurse (RN). License must be active and unrestricted in ... JOB DESCRIPTION **Job Summary** The RN Clinical Appeals Nurse provides support for...hearings as may be required. * Serves as a clinical resource for utilization management, chief medical… more
- Evolent (Frankfort, KY)
- …+ Performs other duties as assigned. **The Experience You'll Need (Required):** + Registered Nurse or Licensed Practical/Vocational Nurse with a current, ... for the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals.… more
- HCA Healthcare (Lexington, KY)
- …experience preferredCertifications, Licenses, and other Special RequirementsCurrent/Active Registered Nurse (RN) License within practice ... **Description** **Introduction** Do you have the career opportunities as a Clinical Manager RN you want with your current employer? We have an exciting opportunity… more
- Molina Healthcare (Lexington, KY)
- …and experience. * At least 5 years health care management/leadership required. * Registered Nurse (RN), Licensed Vocational Nurse (LVN), Licensed Practical ... * Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications * Registered Nurse (RN). License must be active and unrestricted… more
- Molina Healthcare (Lexington, KY)
- …authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse (RN). License must be active and unrestricted in ... JOB DESCRIPTION Job Summary Provides support for clinical member services review assessment processes. Responsible for...to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications *… more
- Molina Healthcare (Lexington, KY)
- For this position we are seeking a (RN) Registered Nurse who must hold a compact license. This is a Remote position, home office with internet connectivity of ... authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse (RN). License must be active and unrestricted in… more
- Highmark Health (Frankfort, KY)
- …years of experience in Managed Care **LICENSES or CERTIFICATIONS** **Required** + Registered Nurse **Preferred** + Certified Medical Coder or related **SKILLS** ... itemized bills, and claims data to assure appropriate level of payment and resource utilization . It is also used to identify issues which can be used for education… more