- Humana (Frankfort, KY)
- …a part of our caring community and help us put health first** The Utilization Management Behavioral Health Professional 2 utilizes behavioral ... and communication of medical services and/or benefit administration determinations. The Utilization Management Behavioral Health Professional… more
- Humana (Frankfort, KY)
- …a part of our caring community and help us put health first** The Manager, Utilization Management Behavioral Health utilizes behavioral health ... and communication of medical services and/or benefit administration determinations. The Manager, Utilization Management Behavioral Health works within… more
- Molina Healthcare (Louisville, KY)
- …& ABILITIES** : + 2 or more years in case, disease or utilization management ; managed care; or medical/ behavioral health settings. + One year of training ... EXPERIENCE** : 5 or more years in case, disease or utilization management ; managed care; or medical/ behavioral health settings. **PREFERRED LICENSE,… more
- Elevance Health (Louisville, KY)
- **Director Behavioral Health Program and Services** **Location:** Alternate locations may be considered. This position will work a hybrid model (remote and ... the Elevance Health family of companies, Carelon Behavioral Health , formerly Beacon Health ...care programs and services, such as Employee Assistance Programs, Utilization Management and Crisis Calls. Works in… more
- CenterWell (Frankfort, KY)
- …training education spanning onboarding to continuing education. **Role Description** The LCSW Behavioral Health Educator will be embedded within the clinical ... team and will oversee training aspects of the cognitive behavioral health screenings, psychosocial assessments, techniques that...has a deep understanding of all the High-risk program management roles and gains the respect and confidence of… more
- Humana (Frankfort, KY)
- …clinical services . Experience in utilization management review and case management in a health plan setting . No current sanction from Federal or ... part of our caring community and help us put health first** The Behavioral Health ...a focus on collaborative business relationships, value-based care, population health , or disease or care management +… more
- Centene Corporation (Frankfort, KY)
- …functions for the business unit. + Provides medical leadership of all for utilization management , cost containment, and medical quality improvement activities. + ... Provides medical expertise in the operation of approved quality improvement and utilization management programs in accordance with regulatory, state, corporate,… more
- Highmark Health (Frankfort, KY)
- …account, and member educational initiatives that promote the Organization's Formularies, utilization management programs, and case/ disease management ... information to improve individual outcomes as an adjunct to health coaching. If acting in the capacity as a...review. + Assist in the development and implementation of utilization management programs including but not limited… more
- BrightSpring Health Services (Louisville, KY)
- …including pharmacy, home health care and primary care, and rehabilitation and behavioral health , we provide comprehensive care and clinical solutions in all ... Health Services Overview Director of Clinical Denials Management and Audit supervises a team of RN/LPN clinical...accredited or approved school.* Two years of experience in health care utilization review or home care.*… more
- Elevance Health (Louisville, KY)
- …member's circle of support and overall management of the individuals physical health (PH)/ behavioral health (BH)/LTSS needs, as required by applicable ... associates, and may be involved in process improvement initiatives. + Submits utilization /authorization requests to utilization management with documentation… more
- Highmark Health (Frankfort, KY)
- …Description :** **JOB SUMMARY** This job captures all inbound inquires for utilization management review from providers and pharmacies. The incumbent assesses ... and then creates the case (data entry) 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
- Molina Healthcare (Louisville, 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. ... performing one or more of the following activities: care review/ utilization management (prior authorizations, inpatient/outpatient medical necessity, etc.),… more
- Elevance Health (Louisville, KY)
- …for over 150 years. With capabilities spanning pharmacy, behavioral health , complex care delivery, medical benefits management , payment integrity, palliative ... involved in Utilization Management , Specialty Benefits Management , Payment Integrity, Advocacy, Health Plan Subrogation, Behavioral Health , … 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)
- …assigned portfolios. Responsibilities include driving operational excellence, leading change management , fostering innovation to improve product health , ... **Company :** Highmark Health **Job Description :** **JOB SUMMARY** This senior...contributing to product transformation and maturity, and strategic utilization of value levers toward outcomes. This involves identifying… more
- Highmark Health (Frankfort, KY)
- …for content creation, identification of customer needs, development, and effective utilization of wellness/population health campaigns and initiatives designed ... **Company :** Highmark Health **Job Description :** **JOB SUMMARY** This job...clinical initiatives/programs to the customer audiences through effective project management , collaboration and application of best practices and engagement.… more
- Elevance Health (Louisville, KY)
- …identification, evaluation, coordination and management of member's needs, including physical health , behavioral health , social services and long term ... care team, to ensure cost effective and efficient utilization of health benefits. + Decision making...management case load, highly preferred. + MA/MS in Health /Nursing preferred. + Travels to worksite and other locations… more
- Highmark Health (Frankfort, KY)
- …(NCQA), Utilization Review Accreditation Committee (URAC), Pennsylvania Department of Health , Department of Labor, the Center for Medicare and Medicaid Services ... review and make determinations regarding physician reviewer assignments for medical management decisions. Cases requiring physician review are provider and member… more
- BrightSpring Health Services (Louisville, KY)
- …including pharmacy, home health care and primary care, and rehabilitation and behavioral health , we provide comprehensive care and clinical solutions in all ... Our Company BrightSpring Health Services Overview The BrightSprings Health ...the analysis and research of business issues, to provide management with valuable insights that support our growth and… 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