- Molina Healthcare (Covington, KY)
- **JOB DESCRIPTION** **_For this position we are seeking a ( RN ) Registered Nurse with previous experience in Hospital Acute Care, Concurrent Review / ... Utilization Review / Utilization Management and knowledge of Interqual / MCG guidelines. WI or COMPACT RN LICENSURE IS REQUIRED within 30 days of… more
- Molina Healthcare (KY)
- …Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG ... guidelines. **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). **MULTI STATE / COMPACT… more
- Fresenius Medical Center (Cadiz, KY)
- …and acts as the liaison for patient care as per the disease management agreement, including initial and ongoing validation of member eligibility. Facilitate timely ... workup of patients for access management , dialysis services, patient education, hospitalizations, and kidney transplantation as appropriate, and ensures coordination… more
- Fresenius Medical Center (Kuttawa, 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
- Humana (Frankfort, KY)
- …supports the goal to put health first? The Prior Authorization, Registered Nurse , RN , Intern will review prior authorization requests for appropriate ... onsite, field, or remote based opportunities. The Prior Authorization, Registered Nurse , RN , Intern will...experience a plus. + Previous experience in prior authorization, utilization management + Experience working with MCG… more
- Molina Healthcare (Florence, KY)
- For this position we are seeking a ( RN ) Registered Nurse who lives in OHIO or KENTUCY and must be licensed for the state they reside Clinical Auditor RN ... **KNOWLEDGE/SKILLS/ABILITIES** + Performs monthly auditing of registered nurse and other clinical functions in Utilization ... nurse and other clinical functions in Utilization Management (UM), Case Management … more
- Highmark Health (Frankfort, KY)
- …and Sunday required in addition to 3 weekdays** This job implements 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
- LifePoint Health (Versailles, KY)
- …and fosters an environment that encourages professional growth. Initiates weekend case management , Utilization review screening, assists with D/C planning ... Requirements Minimum EducationX Associate's degree - Required An Active RN License with KBN or a Compact RN...- within 60 days of hire and renewed annuallyTrauma Nurse Core Course (TNCC) - PreferredENPC - preferredNRP -… more
- Molina Healthcare (Covington, 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
- CenterWell (Bardstown, KY)
- …license, auto insurance and reliable transportation. + Two years as a Registered Nurse with at least one-year of management experience in a home care, ... clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the...School of Nursing. + Current state license as a Registered Nurse . + Proof of current CPR.… more
- Molina Healthcare (Bowling Green, KY)
- … Registered Nursing ( RN ) license in good standing. + Utilization Management Certification (CPHM) Certified Professional in Health Care Quality (CPHQ), ... and results across Molina Health Plans & Segments. **KNOWLEDGE/SKILLS/ABILITIES** + Review existing case management standards and processes and establishes… more
- Catholic Health Initiatives (Lexington, KY)
- …emphasis will be on care coordination, communication and collaboration with utilization management , nursing, physicians, ancillary departments, insurers and post ... their practice. 13. Performs other duties as assigned, including utilization review as necessary. _The job summary...multiple stakeholders + Professional communication skills. + Understand how utilization management and case management … more
- Guardian Life (Frankfort, KY)
- …services. Act as a liaison between all parties required in case management to facilitate collaboration toward RTW goals. Utilization of independent ... **Position Summary** The RN Clinical Consultant serves as a clinical resource...issues, when possible, to enhance the customer experience. **Activity** Review and assess claimant subjective reports and objective medical… more
- ChenMed (Louisville, KY)
- …RN with bachelor's degree in a related clinical field preferred. + A valid, active Registered Nurse ( RN ) license in State of employment required. + A ... people to join our team. * The Acute Care Nurse is responsible for achieving positive patient outcomes, managing...experience required. + A minimum of 1 year of utilization review and/or case management ,… more
- CVS Health (Madisonville, KY)
- …+ Discharge Planning Experience. + Motivational Interviewing skills + Managed Care/ Utilization Review Experience + Clinical experience and demonstrated knowledge ... health care more personal, convenient and affordable. Position Summary: The Complex Nurse Case Manager is responsible for assessing members through regular and… more
- Surgery Care Affiliates (Owensboro, KY)
- …requirements for CRNA practice. Qualifications + Holds current active state licensure as a registered nurse in the state of KY/IN and complies with any ... career opportunities for YOU. Responsibilities A qualified CRNA responsible for the management of nurse anesthesia services in collaboration with facility CEO,… more
- BrightSpring Health Services (Louisville, KY)
- …therapy from an accredited or approved school.* Two years of experience in health care utilization review or home care.* Two years prior home health or hospice ... Our Company BrightSpring Health Services Overview Director of Clinical Denials Management and Audit supervises a team of RN /LPN clinical reviewers as well as… more
- Elevance Health (Louisville, KY)
- **Medical Management Nurse ** **Federal Employee Program - FEP** , a proud member of the Elevance Health, Inc. family of companies, it is a powerful combination, ... pm (EST) shift rotation twice a month.** The **Medical Management Nurse ** is responsible for reviewing the...experience and requires a minimum of 2 years clinical, utilization review , or managed care experience; or… more