- CVS Health (Frankfort, KY)
- …Quality of Care: -Application and/or interpretation of applicable criteria and clinical guidelines, standardized case management plans, policies, procedures, and ... Master's degree in Behavioral /Mental Health or related field** -Unencumbered Independent Behavioral Health clinical license in the state where they work:… more
- CVS Health (Frankfort, KY)
- …of Care: + Application and/or interpretation of applicable criteria and clinical guidelines, standardized case management plans, policies, procedures, and ... Master's degree in Behavioral /Mental Health or related field. + Unencumbered Behavioral Health clinical license in Kentucky (LCSW, LPCC, LMFT) **Anticipated… more
- Molina Healthcare (Lexington, KY)
- …a current active unrestricted license in the state of KY Case Manager will work remotely supporting Medicaid Behavioral health population. Excellent computer ... per regulated timelines and determines who may qualify for case management based on clinical judgment, changes...the assigned members, particular state-specific regulations, or whether the Case Manager position is located within Molina's… more
- Highmark Health (Frankfort, KY)
- …Nursing **EXPERIENCE** **Required** + 7 years of any combination of clinical , case management and/or disease/condition management experience, provider operations ... panel of members that range in health status/severity and clinical needs. The incumbent assesses health management needs of...interventions and referrals, the incumbent will manage an active case load of members in his/her panel that are… more
- CVS Health (Frankfort, KY)
- …all with heart, each and every day. **Position Summary** The High-Fidelity Wraparound (HFW) Case Manager (CM) is a person who safeguards that the principles of ... may impact member outcomes and care planning components with appropriate engagement of clinical case management or crisis intervention as appropriate. - +… more
- Molina Healthcare (Lexington, KY)
- …Nurse who lives in Kentucky and must be licensed for the state of Kentucky. Case Manager RN will work with KY Medicaid population providing telephonic case ... health settings. Preferred License, Certification, Association Active, unrestricted Certified Case Manager (CCM) To all current Molina employees: If… more
- Humana (Frankfort, KY)
- …the Director, Case Management and supports the strategic priorities for Clinical Operations, Medical & Behavioral Health and Humana Government Business ... Puerto Rico. + Current valid and unrestricted Registered Nurse license + Certified Case Manager (CCM) + 5 years of healthcare supervisory/management experience,… more
- Highmark Health (Frankfort, KY)
- …resource utilization, identification of opportunities for referral to a Health Coach/ case management, and identification and resolution of quality issues. Monitors ... with established industry and corporate standards and are within the care manager 's professional discipline. + Function in accordance with applicable state, federal… more
- CenterWell (Lexington, KY)
- …represents the scope of provider relationships across the following areas: + Quality/ clinical management and population health + HEDIS and Stars performance + ... without restriction in applicable state + 5+ years of clinical nursing experience + Proven work experience as a...years of managed care experience + 3+ years of case management experience + Bilingual; English and Spanish preferred,… more
- Highmark Health (Frankfort, KY)
- …Is responsible for or works with external resources to create and monitor inpatient case mix reports and the top 25 assigned DRGs/APCs in the facilities to identify ... related to special projects and providing coverage for coding manager (s). (10%) + Depending on location provides or arranges...processes as it relates to the DRG/APC and other clinical data quality management factors. With technical direction and… more