- Humana (Frankfort, KY)
- **Become a part of our caring community and help us put health first** The Utilization Management Behavioral Health Nurse uses behavioral ... however **must be located and licensed in a Compact State** The Utilization Management Behavioral Health Nurse completes medical record reviews… more
- CVS Health (Frankfort, KY)
- …/benefit management program. **Required Qualifications** + Licensed independent behavioral health clinician with Kentucky state licensure (LCSW, LPCC, ... clinically appropriate treatment, evidence-based care and clinical practice guidelines for Behavioral Health and/or medical conditions based upon program focus.… more
- Humana (Frankfort, KY)
- …value-based care, quality metrics, population health , and disease or care management . The Behavioral Health Medical Director may develop procedures, ... part of our caring community and help us put health first** The Behavioral Health ...management , utilization management , case management , discharge planning and/or home health or… more
- Humana (Frankfort, KY)
- …providing clinical services + Experience in utilization management review and case management in a health plan setting + MUST HAVE ONE OF THE FOLLOWING ... part of our caring community and help us put health first** The Behavioral Health ...a focus on collaborative business relationships, value-based care, population health , or disease or care management *… more
- CVS Health (Frankfort, KY)
- … health care innovators. The Engagement Outreach Hub Care Management Associate supports comprehensive coordination of healthcare services through telephonic ... Bring your heart to CVS Health . Every one of us at CVS ...personal, convenient and affordable. **Position Summary** **Aetna's Medicaid Care Management Engagement Outreach Hub** is a _new_ initiative focused… more
- Evolent Health (Frankfort, KY)
- …Join Evolent for the mission. Stay for the culture. **What You'll Be Doing:** As a Behavioral Health Field Medical Director will be a key member of the ... utilization management team. We can offer you...utilization management team. We can offer you a meaningful way...Opportunities:** Evolent Health is looking for a Behavioral Health Medical Director to be a… more
- CVS Health (Frankfort, KY)
- …assisting care management staff as they support of members' physical, behavioral and socioeconomic needs. * Partner closely with the Executive Director of Duals ... Bring your heart to CVS Health . Every one of us at CVS ... care and social determinant needs. The Duals Care Management (CM) Medical Director will participate in designing, developing… more
- Humana (Frankfort, KY)
- …such as provider relations, claims submission and payment, utilization management processes, behavioral health processes, and dispute resolution. ... part of our caring community and help us put health first** Humana Healthy Horizons is seeking a Senior...educational material, or trainings. + 2+ years of project management experience with mid-size projects. + 1+ years of… more
- Highmark Health (Frankfort, KY)
- …for the patient, and then creates the case (data entry) in Highmark's utilization management system for clinical review. Ensures all accurate information is ... including verification of benefit eligibility. Build cases in the utilization management system. + Use knowledge of...0 - 1 year of experience working in the Health Insurance Industry **LICENSES AND CERTIFICATIONS** **Required** + None… more
- Catholic Health Initiatives (Lexington, KY)
- … working with Medicare/Medicaid and other federal guidelines or 2 years Utilization management in hospital setting. Also desirable, experience in discharge ... planning functions, and monitoring of quality of service throughout the case management process. Performs direct Interqual/M&R utilization review on all acute… 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
- Humana (Frankfort, KY)
- …and subpopulations.** Areas of focus include Care Management , Quality Improvement, Utilization Management , Population Health , Social Determinants of ... Health , Pharmacy, Behavioral Health , Long-Term Services and Supports, Health Information...Qualifications** + MBA programs with a specialization in Healthcare Management **OR** Master's Degree in Public Health … more
- Humana (Frankfort, KY)
- …and subpopulations. Areas of focus include Care Management , Quality Improvement, Utilization Management , Population Health , Social Determinants of ... Health , Pharmacy, Behavioral Health , Institutional Long-Term Services and Supports (LTSS), Home and...Organization (MCO) focusing on Medicaid clinical strategy and population health management strategy. **Alternatively** **,** 5+ years… more
- Highmark Health (Frankfort, KY)
- …and education or if necessary involve Special Investigation Unit or the Utilization Management area. **ESSENTIAL RESPONSIBILITIES** + Implement the pre-payment ... data to assure appropriate level of payment and resource utilization . It is also used to identify issues which...measurable outcomes. Will monitor and analyze the delivery of health care services in accordance with claims submitted, and… more
- Highmark Health (Frankfort, KY)
- **Company :** Highmark Health **Job Description :** Job Description **JOB SUMMARY** This role within the marketing & experience department will be at the forefront ... includes leveraging cutting-edge customer experience platforms, implementing robust data management solutions, and optimizing marketing automation tools to drive… more
- Highmark Health (Frankfort, KY)
- …**Job Description :** **JOB SUMMARY** This job provides application software development management for IT projects. Creates plans and manages activities, within an ... available options, comparing costs and benefits, and recommending solutions. 2 Management Consulting + Identify issues and recommend solutions. + Create presentation… more
- Highmark Health (Frankfort, KY)
- …resource efficiency. + Proposes ideas, designs, and solutions to lead engineers and management to further cloud service utilization and optimization. + Develops ... **Company :** Highmark Health **Job Description :** **JOB SUMMARY** This job...of action. + Level 3 Incident, problem and change management as it pertains to the responsibilities of the… more
- Highmark Health (Frankfort, KY)
- …that the system architecture balances functional, service quality and systems management requirements. + Use appropriate tools, including models of components and ... all levels of organization. + Manage expectations of customers, partners and management . + Participate in customer walkthroughs and plans; design and technical… more
- Highmark Health (Frankfort, KY)
- **Company :** Highmark Health **Job Description :** **JOB SUMMARY** This job is a strong advocate of cloud technology and engineering support necessary to drive the ... to senior or lead engineers to further cloud service utilization and optimization. + Develops automation scripts and other...of action. + Level 2 Incident, problem and change management as it pertains to the responsibilities of the… more
- Veterans Affairs, Veterans Health Administration (Lexington, KY)
- …position is aligned under Surgical Services or Patient Care Services in the Lexington VA Health Care System and works a rotating tour of duty. It is a teaching ... care and helps support family members as needed. Assists member of health care team by obtaining necessary supplies and equipment. Exercises sound judgement… more