- Humana (Frankfort, KY)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...to make an impact** **Required Qualifications** + Active licensed Registered Nurse ( RN ) in the… more
- Humana (Frankfort, KY)
- **Become a part of our caring community and help us put health first** The Utilization Management Behavioral Health Nurse 2 utilizes clinical nursing skills ... and communication of behavioral health services and/or benefit administration determinations. The Utilization Management Behavioral Health Nurse 2 work… more
- Signature Healthcare (Louisville, KY)
- …Care documentation to facility accurate billing. What you Need to make a Difference + Registered Nurse ( RN ) in good standing with required current state ... communication with leadership, patients, families, internal care givers, and external Utilization Management Nurses. + Coordinate internal and external health… more
- Humana (Frankfort, KY)
- …**Use your skills to make an impact** **Required Qualifications** + Active Licensed Registered Nurse ( RN ) in Virginia or enhanced compact license, ... caring community and help us put health first** The Manager, Utilization Management Nursing utilizes clinical nursing skills to support the coordination,… more
- Fresenius Medical Center (Louisville, KY)
- …Classification of Disease (ICD) coding. + Manages clinic financials including efficient utilization of supplies or equipment and regular profits and loss review. + ... of education and experience. + Graduate of an accredited School of Nursing ( RN ). + Current appropriate state licensure. **EXPERIENCE AND SKILLS:** + Required: + 6+… more
- Humana (Frankfort, KY)
- …guidelines/procedures. **Use your skills to make an impact** **Required Qualifications** + Active Licensed Registered Nurse ( RN ) in the state of Virginia or ... licensure + Previous Medicare/Medicaid experience a plus + Previous experience in utilization management , case management , discharge planning and/or home… 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 (Louisville, KY)
- …knowledge on the job. Job Qualifications **REQUIRED EDUCATION** : Completion of an accredited Registered Nurse ( RN ) Program and an Associate's or Bachelor's ... Responsible for the development, implementation, and delivery of training curriculum for Utilization Management , Case Management , and LTSS staff. Leads… more
- Molina Healthcare (Louisville, KY)
- …Chief Medical Officer on denial decisions. + Resolves escalated complaints regarding Utilization Management and Long-Term Services & Supports issues. + ... as may be required. + Serves as a clinical resource for Utilization Management , Chief Medical Officer, Physicians, and Member/Provider Inquiries/Appeals. +… more
- Elevance Health (Louisville, KY)
- RN Nurse Case Manager II (10:30am - 7:00pm Central Time) JR144435 **Work Hours:** Monday - Friday, 10:30am - 7pm Central Time **Locations** : This position is ... with providers, claims or service issues. + Assists with development of utilization /care management policies and procedures. **Minimum Requirements:** + BA/BS in… more
- Molina Healthcare (Louisville, KY)
- …of payment decisions. + Serves as a clinical resource for Utilization Management , Chief Medical Officers, Physicians, and Member/Provider Inquiries/Appeals. ... state/federal regulations **REQUIRED LICENSE, CERTIFICATION, ASSOCIATION:** Active, unrestricted State Registered Nursing ( RN ) license in good standing.… more
- CenterWell (Elizabethtown, KY)
- …license, auto insurance and reliable transportation. + Two years as a Registered Nurse with at least one-year of management experience in a home care, ... clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates...School of Nursing. + Current state license as a Registered Nurse . + Proof of current CPR.… more
- Highmark Health (Frankfort, KY)
- …+ Experience in UM/CM/QA/Managed Care **LICENSES or CERTIFICATIONS** **Required** + United States Registered Nurse ( RN ) license + Delaware RN ... Health **Job Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of health… more
- Molina Healthcare (Louisville, KY)
- …materials and other related documentations. **JOB QUALIFICATIONS** **Required Education** + Registered Nurse or equivalent combination of Licensed Vocational ... Nurse (LVN) or Licensed Practical Nurse (LPN) with experience in lieu of ...years in one or more of the following areas: utilization management , case management , care… more
- Molina Healthcare (Louisville, KY)
- …for internal meetings. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse ( RN ). **Required Experience** 1-3 years of ... **JOB DESCRIPTION** Opportunity for experienced Utilization Review RN in United States...transplants; the ideal candidate will have experience either in utilization review or case management for transplants.… more
- CVS Health (Frankfort, KY)
- …virtual training is also required for this position._** **_This is a full-time Registered Nurse telehealth role supporting clients on the east coast._** **_Work ... regulatory and accreditation guidelines_ **_Required Qualifications_** - _Must be a Registered Nurse with experience facilitating virtual group presentations or… more
- Molina Healthcare (Louisville, KY)
- …Practical Nurse in good standing. **Preferred Education** Completion of an accredited Registered Nurse ( RN ) Program or a bachelor's degree in Nursing. ... contained in the delegation agreement. **KNOWLEDGE/SKILLS/ABILITIES** The Delegation Oversight Nurse is responsible for ensuring that Molina Healthcare's UM… more
- Molina Healthcare (Louisville, KY)
- …driver's license **PREFERRED EDUCATION:** **PREFERRED EXPERIENCE:** + 3-5-year experience as a Registered Nurse and/or Nurse Practitioner, ideally in a ... **JOB DESCRIPTION** **Job Summary** The Care Connections Nurse Practitioners focus on screening and preventive primary care services delivered in the home,… more
- Elevance Health (Louisville, KY)
- …EST per month.** The ** Nurse Case Manager II** is responsible for care management within the scope of licensure for members with complex and chronic care needs ... ** Nurse Case Manager II** **Location: This is a...claims or service issues. + Assists with development of utilization /care management policies and procedures. **Minimum Requirements:**… more
- Elevance Health (Louisville, KY)
- …with providers, claims or service issues. + Assists with development of utilization /care management policies and procedures **Minimum Requirements:** + Requires ... ** Nurse Case Manager II** **Location:** Alternate locations may... Case Manager II** will be responsible for care management within the scope of licensure for members with… more