- 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
- 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
- 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
- Highmark Health (Frankfort, KY)
- …in addition to 3 weekdays** This job implements 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...position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of… 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
- 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
- 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 (Lexington, 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
- Highmark Health (Frankfort, KY)
- …to deliver financial results to the Enterprise. **ESSENTIAL RESPONSIBILITIES** + Perform management responsibilities to include, but are not limited to: involved in ... termination decisions, coaching and development, rewards and recognition, performance management and staff productivity.Plan, organize, staff, direct and control the… 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)
- …contribute to highest levels of performance. **ESSENTIAL RESPONSIBILITIES** + Perform management responsibilities including, but limited to: involved in hiring and ... termination decisions, coaching and development, rewards and recognition, performance management and staff productivity.Plan, organize, staff, direct, and control… more
- Veterans Affairs, Veterans Health Administration (Lexington, KY)
- …location as necessary. Responsibilities Total-Rewards-of-an-Allied- Health -VA-Career-Brochure.pdf Nursing Assistant - ... post-mortem care, and helps support family members as needed.Assists members of health care team by obtaining necessary supplies and equipment. Exercises sound… more
- Highmark Health (Frankfort, KY)
- …sales revenue and expanding market share through new client acquisition and relationship management . The ideal candidate will have a strong background in B2B sales, ... as: Financial Services, Utilities, Property and Casualty Insurance + CRM utilization **Preferred** + Transactional print and mail and digital delivery experience… more
- Molina Healthcare (Lexington, KY)
- …facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long term care, for members with high need ... Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG guidelines.… more
- Molina Healthcare (Lexington, KY)
- …plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care, for members with high need potential. ... years in one or more of the following areas: utilization management , case management , care...management . + Minimum 2 years of healthcare or health plan supervisory or managerial experience, including oversight of… more
- Sharecare (Frankfort, KY)
- …of the health care team to support appropriate total healthcare management and ensure cost effective, appropriate resource utilization and quality outcomes. ... team. Facilitates communication exchange with primary managing physician and other providers, health plan, and the disease management program team. + Coordinates… more
- NASCO (Frankfort, KY)
- …wide (or Plan Enterprise) implementation of product capabilities related to data management and membership or billing processing subsystems. This role aids Plan ... system and assists in defining the development standards, programming, troubleshooting and management of problems affecting IT software to help sustain the highest… more
- Humana (Frankfort, KY)
- …opportunities which may support Member Engagement, Clinical Performance, Provider Engagement, Behavioral Health and Pharmacy. This position reports to Quality ... part of our caring community and help us put health first** The Senior Data and Reporting Professional generates...role is to develop organized analytics, reports and data management to support the market's Quality team within the… more
- Humana (Frankfort, KY)
- …of clinical conditions and disease states, such as hypertension, diabetes, kidney care, behavioral health and/or other chronic conditions + Deep understanding of ... part of our caring community and help us put health first** Humana's Clinical Analytics Team is seeking a...other specific healthcare areas such as EMR, Episode grouper, utilization management , value-based care, low value care… more