- CVS Health (Frankfort, KY)
- …clinically appropriate treatment, evidence based care and clinical practice guidelines for Behavioral Health and/or medical conditions based upon program focus. ... ambulatory care or outpatient clinic/facility. + Valid unrestricted independent professional behavioral health clinical license to practice per state regulations… more
- Molina Healthcare (Lexington, KY)
- …chemical dependency services - working closely with regional medical directors to standardize behavioral health utilization management policies and ... and clinical leadership for health plan and/or market specific utilization management and care management behavioral health programs and… more
- Molina Healthcare (Lexington, KY)
- …licensing mandate. + At least 2 years in case, disease or utilization management ; managed care; or medical/ behavioral health settings. + One year of ... Social Worker/Counseling License. + Certified Case Manager (CCM), Utilization Management Certification (CPHM), Certified Professional in Health Care Quality,… more
- Centene Corporation (Frankfort, KY)
- …and standards. **This is a remote position.** **Ideal candidates will have experience in behavioral health utilization review and ability to work in Eastern ... million members as a clinical professional on our Medical Management / Health Services team. Centene is a diversified,...regulatory guidelines and criteria + Performs concurrent review of behavioral health (BH) inpatient to determine overall… more
- Molina Healthcare (Lexington, KY)
- …program(s) proficiency. Preferred Qualifications * Utilization management , care management , behavioral health and/or long-term services and supports ... * At least 2 years health care experience, preferably in utilization management , care management , and/or managed care, or equivalent combination of… more
- Molina Healthcare (Lexington, KY)
- …with implementing integrated Behavioral Health care management programs. **Knowledge/Skills/Abilities** Provides Psychiatric leadership for utilization ... **JOB DESCRIPTION** **Job Summary** Molina's Behavioral Health function provides leadership and... Health function provides leadership and guidance for utilization management and case management … more
- Molina Healthcare (Lexington, KY)
- …**_Field travel in Detroit, MI_** **Job Summary** Molina's Behavioral Health function provides leadership and guidance for utilization management ... health and substance use services and assists with implementing integrated Behavioral Health care management programs. **Job Duties** * Serves as liaison… more
- Molina Healthcare (Lexington, KY)
- …or more of the following areas: utilization management , care management , care transitions, behavioral health , or equivalent combination of relevant ... Management (CPHM), Certified Professional in Healthcare Quality (CPHQ), or other health care or management certification. + Leadership experience. +… 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
- Highmark Health (Frankfort, KY)
- …of clinical, case/ utilization management and/or disease/condition management experience, or provider operations and/or health insurance experience ... health status/severity and clinical needs; and assesses health management needs of the assigned member...first 6 months of employment. **Preferred** + Certification in utilization management or a related field +… more
- CVS Health (Frankfort, KY)
- …. Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... previous experience in Oncology, Transplant, Specialty Pharmacy, Pediatrics, Medical/Surgical, Behavioral Health /Substance Abuse or Maternity/ Obstetrics experience.… more
- CVS Health (Frankfort, KY)
- …data from all care partners to holistically address all physical and behavioral health conditions including co-morbid and multiple diagnoses that impact ... Care and juvenile justice systems, Adoption Assistance, the delivery of Behavioral Health Services, Trauma-informed Care, ACEs, Crisis Intervention services,… more
- Sharecare (Frankfort, KY)
- …members to become empowered and active participants in their own healthcare management for their chronic condition. By providing health education and ... **Job Description:** Sharecare is the leading digital health company that helps people - no matter...nurse helps to drive cost effective and appropriate resource utilization and desired clinical outcomes. The Disease Management… more
- Highmark Health (Frankfort, KY)
- **Company :** Highmark Health **Job Description :** **JOB SUMMARY** This job plays a key role in ensuring projects (ie change initiatives) meet objectives on time ... and minimize risk to implementation. Works to drive faster adoption, higher ultimate utilization and greater proficiency of the changes that impact employees in the… more
- Highmark Health (Frankfort, KY)
- **Company :** Highmark Health **Job Description :** **JOB SUMMARY** This role is responsible for designing, developing, implementing, supporting, and optimizing ... solutions, networks, and infrastructure. Ensure optimal technology selection, resource utilization , and seamless integration. + Utilize modeling tools to develop… more
- Molina Healthcare (Lexington, KY)
- … health plan's Healthcare Services (clinical operations) teams including Utilization Management (prior-authorization, inpatient review) and Care Management ... an integrated delivery of care across the continuum, including behavioral health and long-term care, for members...(RN) license in good standing. + Utilization Management Certification (CPHM) Certified Professional in Health … more
- Highmark Health (Frankfort, KY)
- **Company :** Allegheny Health Network **Job Description :** Applicants must be authorized to work in the US independently. At this time, we do not offer visa ... of data, analyses, slides and preparation for CMS TEAMS and ED CT Utilization workgroups + Exposure to VBR work, including various programs, models, contracts, etc.… more
- Highmark Health (Frankfort, KY)
- …**Preferred** + 5 years of experience with communications + 3 years of experience in Utilization Review + 3 years of experience in Account Support + 1 year of ... + In-depth knowledge of the pharmacy industry, including benefit design, formulary management , and pharmacy best practices. + Proven ability to interpret and analyze… more
- Molina Healthcare (Lexington, KY)
- …plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care, for members with high need potential. ... Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG guidelines.… more
- HCA Healthcare (Frankfort, KY)
- …services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed ... labor management , including position control, scheduling excellence, productivity management , and premium pay utilization . Maintains staffing to ensure… more