- CVS Health (Frankfort, KY)
- …1+ years of clinical experience in acute or post-acute setting, and 1+ years of Utilization Management / Care Management Experience + Must have active ... additional Nursing Licenses as business needs require. **Preferred Qualifications** Utilization Management experience preferred **Education** Education: Diploma… more
- CenterWell (Frankfort, KY)
- …RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability ... Therapy, DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare… more
- CenterWell (Frankfort, KY)
- …+ Prior clinical experience, managed care experience, DME, Florida Medicaid **OR** utilization management experience + Demonstrates Emotional Maturity + Ability ... Orthopedic procedures + Compact License preferred + Previous experience in utilization management within Insurance industry + Previous Medicare… 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 ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- Elevance Health (Louisville, KY)
- **Medical Management Nurse ** **Location: Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training ... members in different states; therefore, Multi-State Licensure will be required.** The **Medical Management Nurse ** is responsible for review of the most complex… more
- Molina Healthcare (Covington, KY)
- …ensure appropriate reimbursement to providers. + Resolves escalated complaints regarding utilization management and long-term services and supports (LTSS) ... modification of payment decisions. + Serves as a clinical resource for utilization management , CMOs, physicians and member/provider inquiries/appeals. + Provides… more
- ChenMed (Louisville, KY)
- … management programs, clinical meetings and other meetings. The Nurse Practitioner will adhere to strict departmental goals/objectives, standards of performance, ... we need great people to join our team. The Nurse Practitioner (NP) acts as part of the clinical...nursing plan of care, health education, physician referrals, case management referrals, follow-up and clear documentation according to ChenMed… more
- Molina Healthcare (KY)
- …reports submitted to the Eastern US Quality Improvement Collaborative (EQIC) and/or utilization management committees. + Participates as needed in joint ... **JOB DESCRIPTION** **Job Summary** The Delegation Oversight Nurse provides support for delegation oversight quality improvement activities. Responsible for… more
- Surgery Care Affiliates (Owensboro, KY)
- …join our team, they will. Responsibilities A qualified CRNA responsible for the management of nurse anesthesia services in collaboration with facility CEO, Core ... with the CEO on purchasing of supplies and equipment and maximizes efficient utilization + Participates in interviews of qualified Participates in the counseling and… more
- ChenMed (Louisville, KY)
- …expanding and we need great people to join our team. The Registered Nurse , Care Line, is responsible for providing telephonic triage directional patient care advice ... client counseling, patient advocacy, health education and referral and resource management to ChenMed patients and their families. Providing on-call coverage, the… more
- Evolent (Frankfort, KY)
- …Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. Tasks are performed ... medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care across the continuum… more
- Intermountain Health (Frankfort, KY)
- …cost-effective outcomes. Provides focused support to various areas such as utilization management , emergency department, acute, ambulatory and specialty care. ... in examining patterns of health care needs, decisions, lifestyle choices, and utilization of resources that affect their health. + Advocates, educates and coaches… more
- Elevance Health (Louisville, KY)
- …to 8:00 PM EST. The ** Nurse Case Manager II** is responsible for care management within the scope of licensure for members with complex and chronic care needs by ... ** Nurse Case Manager II** **Location:** This role enables...providers, claims or service issues. Assists with development of utilization /care management policies and procedures. **Minimum Requirements:**… more
- Humana (Frankfort, KY)
- …Office products including Word, Excel and Outlook **Preferred Qualifications** + Utilization Review/Quality Management experience + Experience working with MCG ... community and help us put health first** The Appeals Nurse 2 resolves clinical complaints and appeals. The Appeals... 2 resolves clinical complaints and appeals. The Appeals Nurse 2 work assignments are varied and frequently require… more
- Elevance Health (Louisville, KY)
- …with providers, claims or service issues. + Assists with development of utilization /care management policies and procedures. **Minimum Requirements:** + Requires ... ** Nurse Case Manager II** **Work Schedule: M-F 8am-430pm... Case Manager I** I is responsible for care management within the scope of licensure for members with… more
- Elevance Health (Louisville, KY)
- …required.** The **Telephonic Nurse Case Manager II** is responsible for care management within the scope of licensure for members with complex and chronic care ... **Telephonic Nurse Case Manager II** **Hours: Monday - Friday...claims or service issues. + Assists with development of utilization /care management policies and procedures. **Minimum Requirements:**… more
- Jennie Stuart Medical Center, Inc. (Hopkinsville, KY)
- …by obtaining vital signs, providing personal care items and room orientation. Utilization of critical thinking skills in prioritization of care. Ability to identify ... and copying of all paperwork. Coordinates with nursing supervisor and/or materials management for supply items that cannot be obtained from the Pyxis. Ensures… more
- Fresenius Medical Center (Georgetown, 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 (Madisonville, KY)
- …Classification of Disease (ICD) coding. + Manages clinic financials including efficient utilization of supplies or equipment and regular profits and loss review. + ... + Preferred but not required: + 3+ years supervisory or project/program management experience. + Med/surg or ICU/CCU experience. **PHYSICAL DEMANDS AND WORKING… more
- Bon Secours Mercy Health (Paducah, KY)
- …partnership * Interprofessional collaboration and leadership * Understanding and utilization of office and clinical technologies * Compassionate, relationship-based ... for professional actions * Effective stewardship of available resources * Conflict management and resilience * Authority for delegating activities to others, while… more