- Evolent Health (Frankfort, KY)
- …the mission. Stay for the culture. **What You'll Be Doing:** The **Coordinator, Intake Utilization Management ** at Evolent will serve as a point of contact for ... and client contractual agreements. **Collaboration Opportunities** : The Coordinator, Intake Utilization Management reports directly to the Manager, Client… more
- CVS Health (Frankfort, KY)
- …for Aetna. Health Services strategies, policies, and programs are comprised of utilization management , quality management , network management and ... clinical coverage and policies. **Primary Job Duties & Responsibilities:** Behavioral Health Medical Director + Collaborates with health plan Sr Leadership… more
- Highmark Health (Frankfort, KY)
- …:** **JOB SUMMARY** This job implements the effective utilization management strategies including: review of appropriateness of health care services, ... utilization , identification of opportunities for referral to a Health Coach/case management , and identification and resolution...years of post licensure experience in a combination of Behavioral Health Clinical, Case Management … more
- Humana (Frankfort, KY)
- …value-based care, quality metrics, population health , and disease or care management . The Behavioral Health Medical Director may develop procedures, ... part of our caring community and help us put health first** The Behavioral Health ...management , utilization management , case management , discharge planning and/or home health or… more
- Humana (Frankfort, KY)
- …providing clinical services + Experience in utilization management review and case management in a health plan setting + MUST HAVE ONE OF THE FOLLOWING ... 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
- Evolent Health (Frankfort, KY)
- …Join Evolent for the mission. Stay for the culture. **What You'll Be Doing:** As a Behavioral Health Field Medical Director will be a key member of the ... utilization management team. We can offer you...utilization management team. We can offer you a meaningful way...Opportunities:** Evolent Health is looking for a Behavioral Health Medical Director to be a… more
- CVS Health (Frankfort, KY)
- …assisting care management staff as they support of members' physical, behavioral and socioeconomic needs. * Partner closely with the Executive Director of Duals ... Bring your heart to CVS Health . Every one of us at CVS ... care and social determinant needs. The Duals Care Management (CM) Medical Director will participate in designing, developing… more
- Highmark Health (Frankfort, KY)
- …for the patient, and then creates the case (data entry) in Highmark's utilization management system for clinical review. Ensures all accurate information is ... including verification of benefit eligibility. Build cases in the utilization management system. + Use knowledge of...0 - 1 year of experience working in the Health Insurance Industry **LICENSES AND CERTIFICATIONS** **Required** + None… more
- Highmark Health (Frankfort, KY)
- …:** **JOB SUMMARY** This job captures all inbound phone inquires for utilization management review from providers and pharmacies. The incumbent assesses ... coverage, creation of a prior authorization case 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
- Catholic Health Initiatives (Lexington, KY)
- … working with Medicare/Medicaid and other federal guidelines or 2 years Utilization management in hospital setting. Also desirable, experience in discharge ... planning functions, and monitoring of quality of service throughout the case management process. Performs direct Interqual/M&R utilization review on all acute… 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
- Humana (Frankfort, KY)
- …and subpopulations. Areas of focus include Care Management , Quality Improvement, Utilization Management , Population Health , Social Determinants of ... Health , Pharmacy, Behavioral Health , Institutional Long-Term Services and Supports (LTSS), Home and...Organization (MCO) focusing on Medicaid clinical strategy and population health management strategy. **Alternatively** **,** 5+ years… more
- Highmark Health (Frankfort, KY)
- **Company :** Highmark Health **Job Description :** Job Description **JOB SUMMARY** This role within the marketing & experience department will be at the forefront ... includes leveraging cutting-edge customer experience platforms, implementing robust data management solutions, and optimizing marketing automation tools to drive… 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
- Highmark Health (Frankfort, KY)
- …resource efficiency. + Proposes ideas, designs, and solutions to lead engineers and management to further cloud service utilization and optimization. + Develops ... **Company :** Highmark Health **Job Description :** **JOB SUMMARY** This job...of action. + Level 3 Incident, problem and change management as it pertains to the responsibilities of the… more
- Highmark Health (Frankfort, KY)
- …that the system architecture balances functional, service quality and systems management requirements. + Use appropriate tools, including models of components and ... all levels of organization. + Manage expectations of customers, partners and management . + Participate in customer walkthroughs and plans; design and technical… more
- Highmark Health (Frankfort, KY)
- …actions (promotions, hiring, terminations, etc.) Develops talent, Addresses resource management , cultivates capabilities of staff, planning and coordination of work, ... in first-line resolution of complex technical problems 2. Provides Staff Management oversight * Hires, promotes, separates or makes recommendations regarding same… more
- Highmark Health (Frankfort, KY)
- **Company :** Highmark Health **Job Description :** **JOB SUMMARY** This job is a strong advocate of cloud technology and engineering support necessary to drive the ... to senior or lead engineers to further cloud service utilization and optimization. + Develops automation scripts and other...of action. + Level 2 Incident, problem and change management as it pertains to the responsibilities of the… more
- Molina Healthcare (Georgetown, KY)
- …Plan, NCQA, CMS and State Medicaid entities. **Job Duties** + Oversees Utilization Management , Claims, Organizational Credentialing, and Crisis Call Center ... + Lead external collaborative with other agencies in providing oversight of Behavioral Health Administrative Service Organization for monitoring and auditing of… more
- Molina Healthcare (Georgetown, KY)
- …(RN) Registered Nurse with previous experience in Hospital Acute Care, Concurrent Review/ Utilization Review / Utilization Management and knowledge of ... facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long term care, for members with high need… more