- Elevance Health (Louisville, KY)
- **Diagnosis Related Group Clinical Validation Auditor-** **Registered Nurse ** **Location:** This position will work a hybrid model (remote and office). Ideal ... miles of one of our PulsePoint locations. The **Diagnosis Related Group Clinical Validation Auditor** is responsible for auditing inpatient medical records to ensure… more
- Elevance Health (Louisville, KY)
- ** Nurse and CPC - Clinical Fraud...opportunities for fraud and abuse prevention and control. + Review and conducts analysis of claims and medical records ... locations. **Hybrid Workplace Strategy:** 1-2 days in office per week The ** Clinical Fraud Investigator II** is responsible for identifying issues and/or entities… more
- Fresenius Medical Center (Radcliff, KY)
- …or federal surveys. + Participates in the completion of the FMS Administrative Clinical Review . **PHYSICAL DEMANDS AND WORKING CONDITIONS:** + The physical ... requirements. Ensure provision of quality patient care while maintaining cost-effective clinical operations in accordance with all legal, compliance, and regulatory… more
- Fresenius Medical Center (Louisville, KY)
- **About this role:** As a Clinical Manager with Fresenius Medical Care, you will ensure that quality patient care is delivered while maintaining clinical ... or chronic kidney disease. **Training and advancement:** You will enter our Clinical Leadership Program that creates and supports a culture of continuous learning… more
- Elevance Health (Louisville, KY)
- …outpatient precertification, prior authorization, and post service requests. + Refers cases requiring clinical review to a Nurse reviewer. + Responsible for ... I** will be responsible for coordinating cases for precertification and prior authorization review . **How you will make an impact:** + Managing incoming calls or… more
- Elevance Health (Louisville, KY)
- …Provider Finder and follows up with provider on referrals given. + Refers cases requiring clinical review to a nurse reviewer; and handles referrals for ... specialty care. + Processes incoming requests, collection of information needed for review from providers, utilizing scripts to screen basic and complex requests for… more
- Elevance Health (Louisville, KY)
- …outpatient precertification, prior authorization, and post service requests. + Refers cases requiring clinical review to a Nurse reviewer. + Responsible for ... I** will be responsible for coordinating cases for precertification and prior authorization review . **How you will make an impact:** + Managing incoming calls or… more
- Molina Healthcare (Louisville, KY)
- …identified by the Payment Integrity analytical team; requires decision making pertinent to clinical experience + Documents clinical review summaries, bill ... **JOB DESCRIPTION** **Job Summary** Utilizing clinical knowledge and experience, responsible for review...Utilizing clinical knowledge and experience, responsible for review of documentation to ensure medical necessity and appropriate… more
- ChenMed (Louisville, KY)
- …degree in a related clinical field preferred. + A valid, active Registered Nurse (RN) license in State of employment required. + A minimum of 2 years' ... people to join our team. * The Acute Care Nurse is responsible for achieving positive patient outcomes, managing...diagnosis during acute stay and provide PCP documentation to review and add to patient problem list. + Contacts… more
- ChenMed (Louisville, KY)
- …our team. The Nurse Practitioner (NP) acts as part of the clinical operations team and is responsible for providing direct patient care in ChenMed/Jencare ... This position may require participation in risk and quality management programs, clinical meetings and other meetings. The Nurse Practitioner will adhere… more
- Elevance Health (Louisville, KY)
- …care management or case management experience and requires a minimum of 2 years clinical , utilization review , or managed care experience; or any combination of ... **Medical Management Nurse ** **Federal Employee Program - FEP** , a...judgment, critical thinking, and holistic assessment of a member's clinical presentation to determine whether to approve requested service(s)… more
- Veterans Affairs, Veterans Health Administration (Louisville, KY)
- Summary The Registered Nurse First Assistant OR Circulator is responsible and accountable for all elements of the nursing process when providing and/or supervising ... First Assisting, OR circulating and surgical scrub duties. Responsibilities Registered Nurse First Assistants (RNFAs) are functioning in an expanded perioperative… more
- CenterWell (Louisville, KY)
- …clinicians and provides feedback to the clinician. + Works with clinicians to review application of clinical documentation and forms. + Reviews Orientation ... and help us put health first** As an **RN** ** Nurse Preceptor** , you will: + Position is responsible...you will: + Position is responsible for providing practical clinical experience and guidance to field clinicians to include… more
- CenterWell (Clarksville, IN)
- …teamwork and providing a positive and welcoming environment for all. Responsibilities: The Nurse Practitioner (NP) works in our team-based care environment. We are a ... team consists of doctors, advanced practice professionals, Pharm D, Care Coach Nurse , MA, Behavioral health specialist, Quality based Coder, Referral Coordinator and… more
- BrightSpring Health Services (Louisville, KY)
- …(7a-3p EST) Friday, Saturday & Sunday 2p-10p CST (3p-11p EST) This Registered Nurse provides On-Call and Triage for the assigned population in accordance with triage ... (web) chat, or email + Ensure compliance with state/local/payer requirements through review of documentation + Provide coaching and education related to the health… more
- YesCare Corp (Louisville, KY)
- …every 3rd week** Below is a list of your responsibilities as a ** Nurse Practitioner (NP/ARNP)** withYesCare: + Provides typical community standard care based on ... evidenced based medicine for clinical services required including but not limited to sick...in-service education of staff as requested. Participates in monthly review of quality of care and chart reviews as… more
- BrightSpring Health Services (Louisville, KY)
- …(web) chat, or email + Ensure compliance with state/local/payer requirements through review of documentation + Provide coaching and education related to the health ... + Participate in performance improvement activities and maintain ongoing clinical knowledge through inteLPNal/exteLPNal training programs + Document above actions… more
- Fresenius Medical Center (Shepherdsville, KY)
- …regulations at: https://content.intranet.fmcna.com/regulatory-affairs/wp-content/uploads/sites/46/2019/05/Pre-Licensed- Nurse -50-State- Review ... of the hemodialysis health care team as a Registered Nurse Applicant, under the direction or supervision of a...for other staff members. + Routinely meets with the Clinical Manager to discuss personnel and patient care status,… more
- YesCare Corp (Louisville, KY)
- …**Responsibilities** Below is a list of your responsibilities as a **Registered Nurse Charge** with YesCare at the Louisville Detention Center in Louiville, KY ... and other members of the interdisciplinary team to develop and initiate health review . + Supervises the preparation of records of nursing care and other treatments… more
- CenterWell (Louisville, KY)
- …policies and standards. + Assesses staff education needs based on own the review of clinical documentation in addition to feedback and recommendations by ... health first** + Develops, plans, implements, analyzes, and organizes clinical operations for a specific location managed. + Conducts/delegates...Utilization Review staff. Upon completion of the assessment, creates and… more