- 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)
- …an internship that supports the goal to put health first? The Prior Authorization, Registered Nurse , RN , Intern will review prior authorization requests for ... onsite, field, or remote based opportunities. The Prior Authorization, Registered Nurse , RN , Intern will...experience a plus. + Previous experience in prior authorization, utilization management + Experience working with MCG… more
- CVS Health (Frankfort, KY)
- …Health clinician with Kentucky state licensure (LCSW, LPCC, LMFT, LPAT, LP) or a Registered Nurse ( RN ) with active current and unrestricted Kentucky state ... to coordinate, document and communicate all aspects of the utilization /benefit management program. + Applies critical thinking...Health licensure (LCSW, LPCC, LMFT, LPAT, LP) or a Registered Nurse ( RN ) with unrestricted… 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
- Humana (Frankfort, KY)
- …part of our caring community and help us put health first** The Compliance Nurse Auditor reviews utilization management activities and documentation to ... to prevent and detect fraud, waste, and abuse. The RN Compliance Nurse 2, Quality Assurance Audit...care, skilled and/or rehabilitation clinical setting + Experience with utilization management , pre-service denials and/or quality assurance… more
- CenterWell (Louisville, 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
- ChenMed (Louisville, KY)
- …RN with bachelor's degree in a related clinical field preferred. + A valid, active Registered Nurse ( RN ) license in State of employment required. + A ... people to join our team. * The Acute Care Nurse is responsible for achieving positive patient outcomes, managing...experience required. + A minimum of 1 year of utilization review and/or case management , home health,… more
- Molina Healthcare (Louisville, KY)
- **JOB DESCRIPTION** **_For this position we are seeking a ( RN ) Registered Nurse with previous experience in Hospital Acute Care, Concurrent Review/ ... Utilization Review / Utilization Management ...care/medical experience. **Required License, Certification, Association** Active, unrestricted Wisconsin Registered Nursing ( RN ) license in good standing.… more
- Wellpath (La Grange, KY)
- …Surgical experience preferred Licenses/Certifications + Have and maintain current licensure as a Registered Nurse within the state of employment. + Obtain and ... maintain CPR certification **Additional Details** -Candidate needs to be licensed as a Registered Nurse in the state of KY **We are an Equal Employment… more
- Molina Healthcare (Louisville, KY)
- … Registered Nursing ( RN ) license in good standing. + Utilization Management Certification (CPHM) Certified Professional in Health Care Quality (CPHQ), ... _This position requires an actively licensed Registered Nurse_ **JOB DESCRIPTION** **Job Summary** The mission of Clinical Operations is to drive value through an… 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
- LifePoint Health (Versailles, KY)
- …and fosters an environment that encourages professional growth. Initiates weekend case management , Utilization review screening, assists with D/C planning and ... Requirements Minimum EducationX Associate's degree - Required An Active RN License with KBN or a Compact RN...- within 60 days of hire and renewed annuallyTrauma Nurse Core Course (TNCC) - PreferredENPC - preferredNRP -… more
- Elevance Health (Louisville, KY)
- ** Nurse Case Manager II** **National Management and Support** **Location** : This will be a work from home positions with the ideal candidate residing in the ... 11AM - 8 PM The ** Nurse Case Manager II** is responsible for care management within the scope of licensure for members with complex and chronic care needs by… more
- Elevance Health (Louisville, KY)
- **Medical Management Nurse ** **Federal Employee Program - FEP** , a proud member of the Elevance Health, Inc. family of companies, it is a powerful combination, ... pm (EST) shift rotation twice a month.** The **Medical Management Nurse ** is responsible for reviewing the...experience and requires a minimum of 2 years clinical, utilization review, or managed care experience; or any combination… more
- Humana (Frankfort, KY)
- …in a bordering state/district (Washington DC, MD, WV, KY, TN & NC).** + Active Registered Nurse ( RN ) license, or Licensed Mental Health Professional (LMHP) ... in analyzing and interpreting financial trends. + Previous experience in utilization management , discharge planning and/or home health or rehabilitation.… more
- Humana (Frankfort, KY)
- …Training programs may include, but not be limited to, Care Management , Utilization Management , and/or Compliance. RN licensure is required at all ... + Master of Science in Nursing with a focus on nursing education. + Licensed Registered Nurse ( RN ) in the state where you reside with no disciplinary action… more
- Humana (Frankfort, KY)
- …your skills to make an impact** **Required Qualifications** + Associate degree + Active Registered Nurse , ( RN ), License in your state of residence without ... management and/or process improvement experience + Minimum 3 years utilization management experience with exposure to grievance and appeals + Proficient in… more