- 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
- Evolent (Frankfort, KY)
- …the mission. Stay for the culture. **What You'll Be Doing:** The **Coordinator, Intake Utilization Management ** at Evolent will serve as a point of contact for ... and client contractual agreements. **Collaboration Opportunities** : The Coordinator, Intake Utilization Management reports directly to the Manager, … more
- Evolent (Frankfort, KY)
- …the mission. Stay for the culture. **What You'll Be Doing:** The **Coordinator, Intake Utilization Management ** at Evolent will serve as a point of contact for ... and client contractual agreements. **Collaboration Opportunities** : The Coordinator, Intake Utilization Management reports directly to the Manager, Intake … 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
- Molina Healthcare (Louisville, KY)
- …Molina's Behavioral Health function provides leadership and guidance for utilization management and case management programs for mental health ... and chemical dependency services and assists with implementing integrated Behavioral Health care management programs....for utilization management and case management programs for mental health and chemical… more
- Molina Healthcare (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 or utilization management in managed care, medical or behavioral health settings. + Two years of clinical… 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
- BrightSpring Health Services (Louisville, KY)
- …including pharmacy, home health care and primary care, and rehabilitation and behavioral health , we provide comprehensive care and clinical solutions in all ... Health Services Overview Director of Clinical Denials Management and Audit supervises a team of RN/LPN clinical...accredited or approved school.* Two years of experience in health care utilization review or home care.*… more
- Bon Secours Mercy Health (Paducah, KY)
- At Bon Secours Mercy Health , we are dedicated to continually improving health care quality, safety and cost effectiveness. Our hospitals, care sites and ... directs patient teaching activities and coordinates the care provided by health team members. **Essential Job Functions** In collaboration with the interdisciplinary… more
- Elevance Health (Louisville, KY)
- …member's circle of support and overall management of the individuals physical health (PH)/ behavioral health (BH)/LTSS needs, as required by applicable ... associates, and may be involved in process improvement initiatives. + Submits utilization /authorization requests to utilization management with documentation… more
- Highmark Health (Frankfort, KY)
- …:** **JOB SUMMARY** This job captures all inbound phone inquires for utilization management review from providers and pharmacies. The incumbent assesses ... coverage, creation of a prior authorization case in Highmark's Utilization Management system for Prior Authorization clinical...job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of… more
- LifePoint Health (Somerset, KY)
- The Behavioral Health Clinical Program Therapist / Social Worker functions as a member of the Behavioral Health Team in providing independent practice ... levels of psychiatric care for the patients on the Behavioral Health Units. Provides and documents mental...in and knowledge of hospital-based and/or third-party payor case management , utilization management and discharge… more
- Elevance Health (Louisville, KY)
- …identification, evaluation, coordination and management of member's needs, including physical health , behavioral health , social services and long term ... chronic illnesses, co-morbidities, and/or disabilities, to insure cost effective and efficient utilization of health benefits. + Obtains a thorough and accurate… more
- Elevance Health (Louisville, KY)
- …for over 150 years. With capabilities spanning pharmacy, behavioral health , complex care delivery, medical benefits management , payment integrity, palliative ... risk solution spans 100% of the total cost of care for our patients, integrating utilization management , care management , pharmacy management , and data… more
- Magellan Health Services (Fort Campbell, KY)
- …and wellness presentations, and consultation to the assigned brigade/regiments command regarding behavioral health issues with a unique understanding of the ... - Required Clinical Work Experience - Preferred Education - Required Master's - Behavioral Health , Master's - Social Work Education - Preferred License and… more
- Elevance Health (Louisville, KY)
- …A proud member of the Elevance Health family of companies, Carelon Behavioral Health , formerly Beacon Health Options, offers superior clinical mental ... preferred. + Extensive orthopedic surgery experience preferred. + Experience with utilization management , especially with CMS guidelines preferred. For… 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
- Cumberland River Behavioral Health, Inc. (Manchester, KY)
- …well with people of all races, backgrounds and needs + Knowledgeable of Behavioral Health concepts and how to incorporate concepts into practical application ... of psychiatric rehabilitation, effective listening and communication skills, diagnosis and medication management , management of mental health disorders or… 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 (Florence, 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