- CVS Health (Frankfort, KY)
- …care **Preferred Qualifications** + NICU experience highly preferred + Managed care/ utilization review experience + Ability to multitask, prioritize and ... clinical skills to coordinate, document and communicate all aspects of the utilization /benefit management program. Applies critical thinking and knowledge in… more
- Molina Healthcare (Lexington, KY)
- …Responsible for the development, implementation, and delivery of training curriculum for Utilization Management , Case Management , and LTSS staff. Leads ... SKILLS & ABILITIES** : + 2 or more years in case, disease or utilization management ; managed care; or medical/behavioral health settings. + One year of… more
- Humana (Frankfort, KY)
- …part of our caring community and help us put health first** The Utilization Management Behavioral Health Professional 2 utilizes behavioral health knowledge and ... and communication of medical services and/or benefit administration determinations. The Utilization Management Behavioral Health Professional 2 work assignments… more
- Humana (Frankfort, KY)
- …of our caring community and help us put health first** The Manager, Utilization Management Behavioral Health utilizes behavioral health knowledge and skills to ... of medical services and/or benefit administration determinations. The Manager, Utilization Management Behavioral Health works within specific guidelines… more
- Molina Healthcare (Lexington, 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
- Molina Healthcare (Lexington, KY)
- …Practical Nurse (LPN) Program **Required Experience** + Minimum two years Utilization Review experience. + Knowledge of audit processes and applicable state ... contained in the delegation agreement. **KNOWLEDGE/SKILLS/ABILITIES** The Delegation Oversight Nurse is responsible for ensuring that Molina Healthcare's UM… more
- Molina Healthcare (Lexington, KY)
- …Chief Medical Officer on denial decisions. + Resolves escalated complaints regarding Utilization Management and Long-Term Services & Supports issues. + ... be required. + Serves as a clinical resource for Utilization Management , Chief Medical Officer, Physicians, and...the specific programs supported by the plan such as Utilization Review , Medical Claims Review ,… more
- Humana (Frankfort, KY)
- …and help us put health first** The Compliance Nurse 2 reviews case management and utilization management activities and documentation to ensure adherence ... and abuse to ensure appropriate course of action. The Compliance Nurse 2 understands department, segment, and organizational strategy and operating objectives,… more
- CVS Health (Frankfort, KY)
- …in either a clinic or hospital setting._** **_This is a full-time Registered Nurse telehealth role supporting clients on the east coast._** **_Work schedule is in ... _- Assesses members through the use of clinical tools and information/data review , conducts comprehensive evaluation of member's needs and benefit plan eligibility… 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 (Lexington, 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 (Lexington, KY)
- …authorization requests for transplants; the ideal candidate will have experience either in utilization review or case management for transplants. Preference ... **JOB DESCRIPTION** Opportunity for experienced Utilization Review RN in United States...**JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse (RN). **Required Experience** 1-3 years of hospital or… 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
- Molina Healthcare (Lexington, KY)
- …integrated) performing one or more of the following activities: care review / utilization management (prior authorizations, inpatient/outpatient medical ... including 3 or more years in one or more of the following areas: utilization management , case management , care transition and/or disease management… more
- Molina Healthcare (Lexington, KY)
- …Minimum of 6 years' experience in health care * Understanding of clinical operations: utilization management , case management , etc. * Ability to provide ... **Job Description** Looking for a Registrared Nurse or Licensed Social worker to support HealthPlans within Molina Healthcare. In this position you will be assisting… more