- Humana (Frankfort, KY)
- …professional onsite, field, or remote based opportunities. The Prior Authorization, Registered Nurse , RN , Intern will utilize Humana's Medicaid training ... the goal to put health first? The Prior Authorization, Registered Nurse , RN , Intern will...experience a plus. + Previous experience in prior authorization, utilization management + Experience working with MCG… more
- Humana (Lexington, KY)
- …and help us put health first** Humana Healthy Horizons in Kentucky is seeking a Utilization Management Nurse 2 who will utilize clinical nursing skills to ... benefit administration determinations for Humana's Kentucky Medicaid Plan. The Utilization Management Nurse 2 work...30 miles of Lexington or Louisville, Kentucky.** + Licensed Registered Nurse ( RN ) in the… more
- Humana (Frankfort, KY)
- …Family Therapist **(LMFT)** , Licensed Professional Counselor **(LPC)** , Psychologist **(PhD)** , Registered Nurse **( RN )** or other professional license. + ... us put health first** Humana Healthy Horizons in Kentucky is seeking a Utilization Management Behavioral Health Professional 2 who utilizes behavioral health… more
- Highmark Health (Frankfort, KY)
- …Sunday required in addition to 3 weekdays** This job implements effective utilization management strategies including: review of appropriateness of health care ... depending on where clinical care is being provided. **Preferred** + Certification in utilization management or a related field **SKILLS** + Working knowledge of… 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...plan and length of disability. Plan for ongoing case management through proactive partnering with treating providers to move… more
- Molina Healthcare (Lexington, KY)
- … Registered Nursing ( RN ) license in good standing. + Utilization Management Certification (CPHM) Certified Professional in Health Care Quality (CPHQ), ... direction and oversight to the segment clinical teams - specifically care management and utilization management - designed to achieve best in class… more
- Humana (Frankfort, KY)
- …your skills to make an impact** **Required Qualifications** + Associate degree + Active Registered Nurse , ( RN ), License in your state of residence without ... project management and/or process improvement experience + Minimum 3 years utilization management experience with exposure to grievance and appeals +… more