- Catholic Health Initiatives (Lexington, KY)
- …both inside our hospitals and out in the community. **Responsibilities** The Utilization Management (UM) Director is responsible for the market(s) development, ... implementation, evaluation and direction of the Utilization Management Program and staff in support...**Required Education and Experience** **Required** + Bachelor's degree in Nursing , Health Care Administration or advanced clinical degree. +… more
- Veterans Affairs, Veterans Health Administration (Lexington, KY)
- …The Case Manager for the Pain Clinic is directly responsible to the Nurse Manager for PM&R clinics. They are responsible for the provision of continuity ... of care, access, utilization management , clinical guideline implementation and monitoring...requirement for graduation from an approved school of professional nursing to warrant an appointment as a Nurse… more
- Fresenius Medical Center (Lexington, KY)
- **About this role:** As a Clinical Manager with Fresenius Medical Care, you will ensure that quality patient care is delivered while maintaining clinical operations. ... leading your business, and advanced leadership. As a Clinical Manager , you may advance your career into an Area...Disease (ICD) coding. + Manages clinic financials including efficient utilization of supplies or equipment and regular profits and… more
- Prime Therapeutics (Frankfort, KY)
- …+ Clinical and Quality oversight for this program is provided by the Manager , Patient Programs. **Responsibilities** + Registered Nurse (RN). + 5 years ... post-degree clinical experience. + Experience in managed care, specialty drugs, care management and utilization review. + Meets Magellan Credentialing criteria.… more
- Molina Healthcare (Georgetown, KY)
- …of payment decisions. + Serves as a clinical resource for Utilization Management , Chief Medical Officers, Physicians, and Member/Provider Inquiries/Appeals. ... **REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:** + Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical… more
- Humana (Frankfort, KY)
- …services, social sciences, or health related field. + Previous experience in utilization management , discharge planning and/or home health or rehabilitation. + ... first** Humana Healthy Horizons in Virginia is seeking a Manager , Care Management (LTSS-ABD) who will lead...and Supports (LTSS) Waiver Services, in hospice and/or in nursing facilities. They will lead LTSS-ABD care management… more
- Catholic Health Initiatives (Lexington, KY)
- …health 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
- Huron Consulting Group (Frankfort, KY)
- …it promotes a culture of respect, unity, collaboration, and personal achievement. As a Manager , you will have the unique ability to specialize in certain areas that ... talent, training, supervising, coaching/mentoring, and providing feedback through performance management + Facilitate communication and collaboration between all key… more
- Sharecare, Inc. (Frankfort, KY)
- …/ new hire plan selection, claims issues, ID card issues, grievances/appeals, utilization management (UM) status, including but not limited to medical, ... + Claims adjustments + Grievances and appeals submissions + Utilization management intake or status + Complex...Patient Care Technician (PCT) + Physical Therapy Assistant + Nursing Assistant + Medical Secretary/Clinic Manager +… more
- Wolters Kluwer (Frankfort, KY)
- …strategic issues/environment such as competition and publishing strategies. + Project management skills including time/resource utilization , as well as budgeting ... US **OVERVIEW** As a Senior Content Editor (Senior Development Editor) for the Nursing Education and Nursing Practice portfolios, you have an opportunity to… more