- Molina Healthcare (Louisville, KY)
- …Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years of experience in ... more
- CVS Health (Louisville, KY)
- …health care more personal, convenient and affordable. **Position Summary:** The Complex Nurse Case Manager is responsible for assessing members through regular and ... more
- Molina Healthcare (Louisville, KY)
- …Managed Care Experience in the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and Support, ... more
- Elevance Health (Louisville, KY)
- **Telephonic Nurse Case Manager II** **Location: This is a virtual position. Candidates must reside within 50 miles of an Elevance Health Pulse Point location.** ... more
- Molina Healthcare (Louisville, KY)
- …retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. + Attends or chairs committees as required such as ... more
- Elevance Health (Louisville, KY)
- …experience preferred. + Broad knowledge of clinical documentation improvement guidelines, medical claims billing and payment systems, provider billing ... more
- Elevance Health (Louisville, KY)
- …Finder and follows up with provider on referrals given. + Refers cases requiring clinical review to a nurse reviewer; and handles referrals for specialty care. + ... more
- Elevance Health (Louisville, KY)
- …prior authorization, and post service requests. + Refers cases requiring clinical review to a Nurse reviewer. + Responsible for the identification ... more