- Humana (Frankfort, KY)
- …and help us put health first** Humana Healthy Horizons in Ohio is seeking a Utilization Management Nurse 2 who utilizes clinical nursing skills to support ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- Humana (Frankfort, KY)
- …us put health first** Humana Healthy Horizons in Kentucky is seeking a Utilization Management Behavioral Health Professional 2 who utilizes behavioral health ... and communication of medical services and/or benefit administration determinations. The Utilization Management Behavioral Health Professional 2 work assignments… more
- Elevance Health (Louisville, KY)
- **Title: Utilization Management Representative II** **Location:** This position will work a hybrid model (remote and office). Ideal candidates will live within ... 50 miles of one of our PulsePoint locations. The ** Utilization Management Representative II** will be responsible...provider on referrals given. + Refers cases requiring clinical review to a nurse reviewer; and handles… more
- Elevance Health (Louisville, KY)
- Job Description **Title: Utilization Management Representative I** **Location:** This position will work a hybrid model (remote and office). Ideal candidates ... 50 miles of one of our PulsePoint locations. The ** Utilization Management Representative I** will be responsible...and post service requests. + Refers cases requiring clinical review to a Nurse reviewer. + Responsible… more
- Elevance Health (Louisville, KY)
- **Title: Utilization Management Representative I** **Location:** This position will work a hybrid model (remote and office). Ideal candidates will live within 50 ... miles of one of our PulsePoint locations. The ** Utilization Management Representative I** will be responsible...and post service requests. + Refers cases requiring clinical review to a Nurse reviewer. + Responsible… more
- Molina Healthcare (Owensboro, 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
- ChenMed (Louisville, KY)
- …of 2 years' clinical work experience required. + A minimum of 1 year of utilization review and/or case management , home health, hospital discharge planning ... people to join our team. * The Acute Care Nurse is responsible for achieving positive patient outcomes, managing...patients' progress and adjust and plan accordingly. + Understanding utilization review and how to leverage with… more
- Humana (Frankfort, KY)
- …Previous Medicare/Medicaid experience a plus. + Previous experience in prior authorization, utilization management + Experience working with MCG or Interqual ... goal to put health first? The Prior Authorization, Registered Nurse , RN, Intern will review prior authorization... depending on case findings. + Educates providers on utilization and medical management processes. + Enters… more
- ChenMed (Louisville, KY)
- …explain nurse practitioner role. + Facilitates patient/family conferences to review treatment goals, optimize resource utilization , provide family education ... we need great people to join our team. The Nurse Practitioner (NP) acts as part of the clinical...management programs, clinical meetings and other meetings. The Nurse Practitioner will adhere to strict departmental goals/objectives, standards… more
- Surgery Care Affiliates (Owensboro, KY)
- …career opportunities for YOU. Responsibilities A qualified CRNA responsible for the management of nurse anesthesia services in collaboration with facility CEO, ... as part of Optum and with our new Specialty Management Solutions business. + We have pioneered a physician-led,...on purchasing of supplies and equipment and maximizes efficient utilization + Participates in interviews of qualified Participates in… 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
- Elevance Health (Louisville, KY)
- …criteria._** 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** **Location: This is a...claims or service issues. + Assists with development of utilization /care management policies and procedures. **Minimum Requirements:**… 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
- Molina Healthcare (Covington, KY)
- …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 employment._** **_Ability/knowledge to cross train, inpatient medical to inpatient BH or inpatient Medical to PA is preferred._** **_Excellent computer skills and attention to detail are very… more
- Molina Healthcare (Lexington, KY)
- … and effective resource management . + Develops and implements a Utilization Management program and action plan, which includes strategies that ensure ... IT and data analysts to produce tools to report, monitor and improve Utilization Management . + Actively participates in regulatory, professional and community… more
- Evolent (Frankfort, KY)
- …for operational performance of physician, nursing, and shared services staff in the utilization management value chain + Owns clinical rationale for ... point of responsibility for all clinical operations inclusive of nurse , physician, and shared services performance. and core work...utilization management decisions made by all clinical staff + Ensures… more
- CenterWell (Bowling Green, KY)
- …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and ... requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking...and reliable transportation. + Two years as a Registered Nurse with at least one-year of management … more
- Evolent (Frankfort, KY)
- …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and client policies and ... behind it. **What You'll Be Doing:** The Evolent Appeals Nurse team offers candidates the opportunity to make a...and regulations. * Practices and maintains the principles of utilization management and appeals management … more
- Veterans Affairs, Veterans Health Administration (Louisville, KY)
- …care team, or other specialty care. Coordinates with the patient care team to review the clinic utilization by using various reports (eg, Clinic Utilization ... effective and efficient communication with the patient, interdisciplinary team, management team, VA medical centers, and other agencies. Collect, scans,… more