- Evolent (Frankfort, KY)
- …Evolent for the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior ... policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as... medical necessity and appropriateness of services using clinical review criteria. + Accurately documents all… more
- Molina Healthcare (Covington, KY)
- **Job Description** **Job Summary** The Medical Review Nurse provides support for medical claim and internal appeals review activities - ensuring ... Michigan RN license is required. **Job Duties** + Facilitates clinical / medical reviews of retrospective medical ...nursing experience, including at least 1 year of utilization review , medical claims review , long-term… more
- Fresenius Medical Center (Georgetown, KY)
- …or federal surveys. + Participates in the completion of the FMS Administrative Clinical Review . **PHYSICAL DEMANDS AND WORKING CONDITIONS:** + The physical ... requirements. Ensure provision of quality patient care while maintaining cost-effective clinical operations in accordance with all legal, compliance, and regulatory… more
- Fresenius Medical Center (Madisonville, KY)
- **About this role:** As a Clinical Manager with Fresenius Medical Care, you will ensure that quality patient care is delivered while maintaining clinical ... kidney disease. **Training and advancement:** You will enter our Clinical Leadership Program that creates and supports a culture...a tremendous asset that sets us apart. At Fresenius Medical Care, you will truly make a difference in… more
- Bon Secours Mercy Health (Paducah, KY)
- …as an RN (required) + Experience with discharge planning or utilization review (preferred) **Skills & Abilities:** Hard/Tech/ Clinical Skills _:_ + Discharge ... effectiveness. Our hospitals, care sites and clinicians are recognized for clinical and operational excellence. **Mercy Health** Intro paragraph As a faith-based… more
- Elevance Health (Louisville, KY)
- …states; therefore, Multi-State Licensure will be required.** The ** Medical Management Nurse ** is responsible for review of the most complex or challenging ... ** Medical Management Nurse ** **Location: Virtual: This...management experience and requires a minimum of 2 years clinical , utilization review , or managed care experience;… more
- ChenMed (Louisville, KY)
- …join 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 ... and summaries. The Nurse Practitioner (NP) acts as part of the clinical operations team and is responsible for providing direct patient care in ChenMed/Jencare … more
- Surgery Care Affiliates (Owensboro, KY)
- …work schedules and assignments, and emergency changes in collaboration with the CEO and Clinical Leaders. + Leading peer review for anesthesia at the facility. + ... we make is rooted in seven core values: + Clinical quality + Integrity + Service excellence + Teamwork...by the National Board of Certification and Recertification for Nurse Anesthetists. + Insurable by an appropriate medical… more
- Veterans Affairs, Veterans Health Administration (Lexington, KY)
- …management practices that include effective labor and performance management leadership skills and clinical skills of a registered nurse at the same grade. The ... determined by the VHA Education Loan Repayment Services program office after review of the EDRP application. Former EDRP participants ineligible to apply.… more
- Humana (Frankfort, KY)
- …guidance where needed. Follows established guidelines/procedures. **KEY ACCOUNTABILITIES** + Review medical documentation, obtain additional information that may ... community and help us put health first** The Appeals Nurse 2 resolves clinical complaints and appeals....TRICARE, all HGB policies and procedures as well as medical necessity review criteria and privacy requirements… more
- Veterans Affairs, Veterans Health Administration (Louisville, KY)
- …positions are filled. Responsibilities VA Careers - Licensed Practical Nurse : https://youtube.com/embed/Ae85IP1Oiz4 Total Rewards of a Allied Health Professional ... This Licensed Practical Nurse (LPN) position is located within Primary Care at...a VHA Patient Aligned Care Team (PACT), a patient-centered medical home model of care that is accessible, timely,… more
- Humana (Frankfort, KY)
- …and help us put health first** The Nurse Auditor 2 performs clinical audit/validation processes to ensure that medical record documentation and diagnosis ... independent determination of the appropriate courses of action. The Nurse Auditor 2 validates and interprets medical ...coding experience to conduct a clinical validation review of the inpatient medical record to… more
- Cardinal Health (Frankfort, KY)
- …both scheduled outbound calls and inbound call queue. + Meets regularly with Clinical Supervisor and/or Senior Nurse , Individualized Care to discuss feedback ... who need them-faster.** **_What Individualized Care contributes to Cardinal Health_** Clinical Operations is responsible for providing clinical specialties… more
- HCA Healthcare (Bowling Green, KY)
- …upon timeframe, or 4 years of related experience required. + 3 years of clinical experience as a Registered Nurse required. + Prior leadership experience ... colleagues. The available plans and programs include: + Comprehensive medical coverage that covers many common services at no...opportunity compelling, we encourage you to apply for our Nurse House Supervisor PRN opening. We promptly review… more
- HCA Healthcare (Bowling Green, KY)
- …learning is important to you, we encourage you to apply for our Ortho Nurse opening. Our team will promptly review your application. Highly qualified candidates ... in their positions. Join our Team as a(an) Ortho Nurse and access programs to assist with every stage...colleagues. The available plans and programs include: + Comprehensive medical coverage that covers many common services at no… more
- HCA Healthcare (Frankfort, KY)
- …$25,000 Sign-On Bonus Do you have the career opportunities as a(an) Step Down Nurse you want with your current employer? We have an exciting opportunity for you ... to join Frankfort Regional Medical Center which is part of the nation's leading...Do you want to work as a(an) Step Down Nurse where your passion for creating positive patient interactions… more
- HCA Healthcare (Lexington, KY)
- …our Registered Nurse Home Health opening. Our team will promptly review your application. Highly qualified candidates will be contacted for interviews. **Unlock ... in their positions. Join our Team as a(an) Registered Nurse Home Health and access programs to assist with...colleagues. The available plans and programs include: + Comprehensive medical coverage that covers many common services at no… more
- HCA Healthcare (Bowling Green, KY)
- …step in your career path, we encourage you to apply for our Progressive Care Nurse opening. We review all applications. Qualified candidates will be contacted by ... you have the career opportunities as a Progressive Care Nurse you want in your current role? We invest...6 months of hire ** + **One year of clinical nursing experience preferred ** **Benefits** TriStar Greenview Regional… more
- Vatica Health (Glasgow, KY)
- …is seeking clinically experienced and detailed-oriented nurses to join our team. As a Nurse Consultant, you will collect, review and analyze patient data to ... improve care coordination, quality metrics, and medical cost savings. The ideal candidate has a track...+ Minimum of 3 years of recent adult health clinical experience as a Registered Nurse (RN)-… more
- Datavant (Frankfort, KY)
- …years of CDI experience + 3+ years of clinical experience in an academic medical center + Registered Nurse license, Bachelor's degree in Nursing + CCDS or ... realize our bold vision for healthcare. **What We're Looking For:** As a Clinical Documentation Quality Improvement (CDQI) Specialist, you will play a pivotal role… more