- Humana (Louisville, KY)
- …of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, ... services and/or benefit administration determinations for Humana's Kentucky Medicaid Plan. The Utilization Management Nurse 2 work assignments are varied… more
- 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
- ChenMed (Louisville, KY)
- …discharge to all stakeholders including patient, patient's family or designee, PCP, Center Manager and Community Care Nurse . + Documents the appropriate date ... and evaluate individual patient care plans. + Knowledge of nursing and case management theory and practice....experience required. + A minimum of 1 year of utilization review and/or case management , home health,… more
- Fresenius Medical Center (Bowling Green, KY)
- …and acts as the liaison for patient care as per the disease management agreement, including initial and ongoing validation of member eligibility. Facilitate timely ... workup of patients for access management , dialysis services, patient education, hospitalizations, and kidney transplantation as appropriate, and ensures coordination… more
- Bon Secours Mercy Health (Paducah, KY)
- …assigned team members as assigned. The RN is responsible to the System Flex Nurse Manager for the assigned Department. System Flex Team Registered Nurse ... Bachelors of Science, nursing (preferred) **Experience** + One year as a Registered Nurse , minimum with nursing experience in specialty + 4-5 years as a… more
- Fresenius Medical Center (Louisville, 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
- Select Medical (Danville, KY)
- …by doing what is right. The Case Manager is responsible for utilization reviews and resource management , discharge planning, treatment plan management ... **Overview** **Critical Illness Recovery Hospital** **Case Manager (PRN)** _Requires a current licensure in a...the plan of care. + Demonstrates compliance with facility-wide Utilization Management policies and procedures. + Coordinates… more
- Elevance Health (Louisville, KY)
- …1-2 late nights per month required 11:30am - 8:00pm ET The ** Nurse Case Manager II** is responsible for care management within the scope of licensure for ... with providers, claims or service issues. + Assists with development of utilization /care management policies and procedures. **Minimum Requirements:** + Requires… more
- ChenMed (Louisville, KY)
- … management programs, clinical meetings and other meetings. The Nurse Practitioner will adhere to strict departmental goals/objectives, standards of performance, ... local travel EDUCATION AND EXPERIENCE CRITERIA: + ARNP or similar advanced degree in Nursing required + Current Nurse Practitioner Certification in the State of… more
- AdventHealth (Manchester, KY)
- …or Clay County depending on RN. **The role you'll contribute:** The Home Health Registered Nurse (RN) Care Manager is a professional nurse who coordinates ... **Registered Nurse RN *Sign On Bonus** **All the benefits...care based on individual patient needs. The RN Care Manager is responsible for independent management of… more
- Addiction Recovery Care (Ashland, KY)
- …Key Experience and Education Needed: + Master's level or bachelor's level Registered Nurse with working knowledge and experience in nursing principles and ... of every thing we do! We are hiring a Nursing Supervisor for our growing team within our in-patient...for promoting and maintaining quality patient care through effective management of the activities of the total patient care… 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
- Elevance Health (Louisville, KY)
- Nurse Audit Lead - Carelon Payment Integrity **Location:** The ideal candidate will live within 50 miles of one of our pulse point locations and will work on a ... is determined to recover, eliminate, and prevent unnecessary medical-expense spending. The ** Nurse Audit Lead** is responsible for leading a team of clinicians… more
- Molina Healthcare (Bowling Green, 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
- Elevance Health (Louisville, KY)
- **Telephonic Nurse Disease Management II** **$2000 Sign on Bonus** At **Federal Health Products and Services - FHPS** , a proud member of the Elevance Health, ... and Experiences:** + Must be eligible for a multi-state license. + BS in nursing preferred. + Prior case management experience is preferred. + Prior disease… 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
- Highmark Health (Frankfort, KY)
- …Inc. **Job Description :** **JOB SUMMARY** This job implements the effective utilization management strategies including: review of appropriateness of health ... Management + Experience in a clinical setting **Preferred** + Certification in utilization management or a related field + Experience in UM/CM/QA/Managed Care… 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
- ZOLL Medical Corporation (Louisville, KY)
- …patients suffering from serious cardiopulmonary and respiratory conditions.The Cardiac Management Solutions division of ZOLL Medical Corporation develops products to ... points include: Physicians (Cardiologists, Electrophysiologists, Hospitalists, CT Surgeons etc.), Nurse Practitioners, Physician Assistants, nurses, case managers and administrators.… more