- Molina Healthcare (Louisville, KY)
- …decisions for appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical /medical ... 4 weeks Monday-Thursday and Wed - Saturday._** **JOB DESCRIPTION** **Job Summary** Clinical Appeals is responsible for making appropriate and correct clinical … more
- Fresenius Medical Center (Louisville, KY)
- **About this role:** As a Clinical Manager with Fresenius Medical Care, you will ensure that quality patient care is delivered while maintaining clinical ... or chronic kidney disease. **Training and advancement:** You will enter our Clinical Leadership Program that creates and supports a culture of continuous learning… more
- Elevance Health (Louisville, KY)
- …Provider Finder and follows up with provider on referrals given. + Refers cases requiring clinical review to a nurse reviewer; and handles referrals for ... specialty care. + Processes incoming requests, collection of information needed for review from providers, utilizing scripts to screen basic and complex requests for… more
- Elevance Health (Louisville, KY)
- …outpatient precertification, prior authorization, and post service requests. + Refers cases requiring clinical review to a Nurse reviewer. + Responsible for ... I** will be responsible for coordinating cases for precertification and prior authorization review . **How you will make an impact:** + Managing incoming calls or… more
- Molina Healthcare (Louisville, KY)
- …identified by the Payment Integrity analytical team; requires decision making pertinent to clinical experience + Documents clinical review summaries, bill ... **JOB DESCRIPTION** **Job Summary** Utilizing clinical knowledge and experience, responsible for review...Utilizing clinical knowledge and experience, responsible for review of documentation to ensure medical necessity and appropriate… more
- Molina Healthcare (Louisville, KY)
- **Job Description** Job Summary Creates and delivers clinical training programs for clinical staff across the enterprise to orient employees to Molina ... clinical methodology, along with policies, processes and systems. Ensures...Qualifications **REQUIRED EDUCATION** : Completion of an accredited Registered Nurse (RN) Program and an Associate's or Bachelor's Degree… more
- ChenMed (Louisville, KY)
- …our team. The Nurse Practitioner (NP) acts as part of the clinical operations team and is responsible for providing direct patient care in ChenMed/Jencare ... This position may require participation in risk and quality management programs, clinical meetings and other meetings. The Nurse Practitioner will adhere… more
- Elevance Health (Louisville, KY)
- ** Nurse Audit Sr** **Location:** This position will work virtual. Ideal candidates will live within 50 miles of one of our Pulse Point locations. Carelon Payment ... determined to recover, eliminate and prevent unnecessary medical-expense spending." The ** Nurse Audit Sr** is responsible for identifying, monitoring, and analyzing… more
- Molina Healthcare (Louisville, KY)
- …contained in the delegation agreement. **KNOWLEDGE/SKILLS/ABILITIES** The Delegation Oversight Nurse is responsible for ensuring that Molina Healthcare's UM ... as well as Molina Healthcare business needs. In addition, the Delegation Oversight Nurse will assist the Delegation Oversight Manager with additional duties of the… more
- CareerStaff Unlimited (Jeffersonville, IN)
- Licensed Practical Nurse - LPN - Home Health Invest in your future by discovering a facility in Jeffersonville, IN with resources, technology, and opportunities that ... impact the rest of your healthcare career. Licensed Practical Nurse 's are valued members of the care team that...and 401(k) * Guaranteed Weekly Direct Deposit * 24/7 Clinical Services Team & Unparalleled Support * Bonus Programs… more
- CenterWell (Clarksville, IN)
- …teamwork and providing a positive and welcoming environment for all. Responsibilities: The Nurse Practitioner (NP) works in our team-based care environment. We are a ... team consists of doctors, advanced practice professionals, Pharm D, Care Coach Nurse , MA, Behavioral health specialist, Quality based Coder, Referral Coordinator and… more
- BrightSpring Health Services (Louisville, KY)
- …PART TIME Schedule: Friday, Saturday, Sunday 6a-2p CST (7a-3p EST) This Registered Nurse provides On-Call and Triage for the assigned population in accordance with ... (web) chat, or email + Ensure compliance with state/local/payer requirements through review of documentation + Provide coaching and education related to the health… more
- CVS Health (Jeffersontown, KY)
- …8am-5pm, is required. **Evaluation of Members:** + Through the use of clinical assessment tools and evaluating information/data review , conducts a comprehensive ... health care more personal, convenient and affordable. **Position Summary:** The Complex Nurse Case Manager is responsible for assessing members through regular and… more
- Fresenius Medical Center (Louisville, KY)
- …regulations at: https://content.intranet.fmcna.com/regulatory-affairs/wp-content/uploads/sites/46/2019/05/Pre-Licensed- Nurse -50-State- Review ... of the hemodialysis health care team as a Registered Nurse Applicant, under the direction or supervision of a...for other staff members. + Routinely meets with the Clinical Manager to discuss personnel and patient care status,… more
- Elevance Health (Louisville, KY)
- **Telephonic Nurse Case Manager II** **Location: This is a virtual position. Ideal candidates will reside within 50 miles of an Elevance Health Pulse Point ... hours of receipt and meet the criteria._** The **Telephonic Nurse Case Manager II** is responsible for performing care...a BA/BS in a health-related field; 5 years of clinical experience; or any combination of education and experience,… more
- YesCare Corp (Louisville, KY)
- …**Responsibilities** Below is a list of your responsibilities as a **Registered Nurse Charge** with YesCare at the Louisville Detention Center in Louiville, KY ... and other members of the interdisciplinary team to develop and initiate health review . + Supervises the preparation of records of nursing care and other treatments… more
- CenterWell (Louisville, KY)
- …policies and standards. + Assesses staff education needs based on own the review of clinical documentation in addition to feedback and recommendations by ... caring community and help us put health first** The ** Clinical Manager** coordinates and oversees all direct care patient...Utilization Review staff. Upon completion of the assessment, creates and… more
- HCA Healthcare (Louisville, KY)
- …in Nursing (BSN) Degree + Experiential Qualifications: Minimum of two (2) years of clinical experience as a Registered Nurse and per State Board of Nursing ... are currently looking for an ambitious Nursing Faculty - Clinical to help us reach our goals. Unlock your...effectively in the healthcare environment. 4. Participates in the review of the curriculum to ensure integrity, rigor, and… more
- Elevance Health (Louisville, KY)
- **Diagnosis Related Group Clinical Validation Auditor-RN** **Location:** This position will work a hybrid model (remote and office). Ideal candidates will live ... miles of one of our PulsePoint locations. The **Diagnosis Related Group Clinical Validation Auditor** is responsible for auditing inpatient medical records to ensure… more
- Molina Healthcare (Louisville, KY)
- **Job Description** Looking for a Registrared Nurse or Licensed Social worker to support HealthPlans within Molina Healthcare. In this position you will be assisting ... with internet connectivity of high speed required. **Job Summary** The Sr. Clinical Performance Consultant is responsible for the successful execution of clinical… more