- 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 ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- CVS Health (Frankfort, KY)
- …computer use **Required Qualifications** + 1+ year varied Utilization Management experience within an inpatient/Outpatient setting, concurrent review or ... 3 weeks training with 100% participation during 8:30am-5pm Monday-Friday. + A Registered Nurse that must hold an unrestricted license in their state of residence,… more
- CVS Health (Frankfort, KY)
- …convenient and affordable. **Position Summary** This is a fully **remote** Utilization Review Clinical Consultant with a schedule of **Tuesday-Saturday.** ... the standard schedule based on business needs **Preferred Qualifications** + Managed care/ utilization review experience + Ability to multitask, prioritize and… more
- Molina Healthcare (Lexington, KY)
- …of payment decisions. + Serves as a clinical resource for Utilization Management , Chief Medical Officers, Physicians, and Member/Provider Inquiries/Appeals. ... SKILLS & ABILITIES:** + Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years… more
- Prime Therapeutics (Frankfort, KY)
- …of post-degree clinical experience. + Experience in managed care, specialty drugs, care management and utilization review . + Meets Magellan Credentialing ... and drives every decision we make. **Job Posting Title** Infusion Referral Nurse - REMOTE **Job Description Summary** Under supervision, is responsible for performing… more
- Fresenius Medical Center (Lexington, KY)
- …auditing activities. + Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. + Manages clinic ... financials including efficient utilization of supplies or equipment and regular profits and...of supplies or equipment and regular profits and loss review . + Responsible for all required network reporting and… more
- Molina Healthcare (Lexington, KY)
- …are seeking a (RN) Registered Nurse with previous experience in Acute Care, Concurrent Review / Utilization Review / Utilization Management and ... Medical, or ER unit. **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). To all current Molina… more
- Molina Healthcare (Lexington, KY)
- …to work a schedule using Pacific time zone. Previous experience working in utilization management for another MCO is preferred. This position is fully ... meetings. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse (RN). **Required Experience** 1-3 years of hospital or medical… more
- Catholic Health Initiatives (Lexington, KY)
- …service throughout the case management process. Performs direct Interqual/M&R utilization review on all acute admissions. **Essential Key Job ... health working with Medicare/Medicaid and other federal guidelines or 2 years Utilization management in hospital setting. Also desirable, experience in discharge… more
- Catholic Health Initiatives (Lexington, KY)
- …of new Epic functionality as assigned including the following responsibilities: a. Review of the functionality to determine scope and resources required b. Develop ... schedule e. Identify and coordinate communication needs 2. Provides oversight and management of all assigned projects from initial kick-off through conclusion of… 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 ... Care (Physical Training) - within 60 days of hire and renewed annuallyTrauma Nurse Core Course (TNCC) - PreferredENPC - preferredNRP - preferredNIHSS - required… more
- Fresenius Medical Center (Mount Sterling, KY)
- …dialysis clinic. You will collaborate with the Medical Director and the Charge Nurse regarding the provision of quality patient care in the dialysis clinic. ... data collections and auditing activities. + Manages clinic financials including efficient utilization of supplies or equipment and regular profits and loss review… more