- 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
- Lincoln Financial Group (Frankfort, KY)
- …Experience and/or proficiency with Disability Management (STD/LTD) knowledge, Workers Compensation, Utilization Review and/or nurse case management ... Role at a Glance** We are excited to bring on a highly motivated Nurse Disability Consultant to our clinical organization. This position will be responsible for… 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. ... SKILLS & ABILITIES:** + Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years… more
- ChenMed (Louisville, KY)
- …of 2 years' clinical work experience required. + A minimum of 1 year of utilization review and/or case management , home health, hospital discharge planning ... people to join our team. * The Acute Care Nurse is responsible for achieving positive patient outcomes, managing...patients' progress and adjust and plan accordingly. + Understanding utilization review and how to leverage with… more
- Elevance Health (Louisville, KY)
- …**How you will make an impact:** + Develops, maintains, and enhances the claims review process. + Assists management with developing unit goals, policies, and ... Nurse Audit Lead - Carelon Payment Integrity **Location:**...responsible for identifying, monitoring, and analyzing aberrant patterns of utilization and/or fraudulent activities by healthcare providers through prepayment… more
- Humana (Louisville, KY)
- …for review depending on case findings. Educates providers on utilization and medical management processes. Enters and maintains pertinent clinical ... carriers + Previous Medicare/Medicaid experience a plus + Previous experience in utilization management , case management , discharge planning and/or home… more
- ChenMed (Louisville, KY)
- …explain nurse practitioner role. + Facilitates patient/family conferences to review treatment goals, optimize resource utilization , provide family education ... we need great people to join our team. The Nurse Practitioner (NP) acts as part of the clinical...management programs, clinical meetings and other meetings. The Nurse Practitioner will adhere to strict departmental goals/objectives, standards… more
- Wellpath (Beattyville, KY)
- …care through adherence to policies and procedures for admission and transfer, utilization review , and referrals. + Assumes responsibility and accountability for ... of care support. **How you make a difference** The Psychiatric Nurse Practitioner(Psych NP)follows established policies and procedures and state guidelines, ensuring… 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 (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
- Fresenius Medical Center (Louisville, 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)
- …with previous experience in Hospital Acute Care, Concurrent Review / Utilization Review / Utilization Management and knowledge of Interqual / MCG ... Medical, or ER unit. **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). To all current Molina… more
- Sedgwick (Frankfort, KY)
- …and consult review ; and two (2) years of experience in daily application of nurse auditing, utilization review and bill review . **Skills & ... Great Place to Work(R) Most Loved Workplace(R) Forbes Best-in-State Employer RN Bill Review **PRIMARY PURPOSE** **:** To review hospital and professional medical… more
- Molina Healthcare (Florence, 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
- Molina Healthcare (Louisville, KY)
- … and effective resource management . + Develops and implements a Utilization Management program and action plan, which includes strategies that ensure ... IT and data analysts to produce tools to report, monitor and improve Utilization Management . + Actively participates in regulatory, professional and community… more
- Highmark Health (Frankfort, KY)
- …Inc. **Job Description :** **JOB SUMMARY** This job implements the effective utilization management strategies including: review of appropriateness of ... and offers interventions and/or alternatives. **ESSENTIAL RESPONSIBILITIES:** + Implement care management review processes that are consistent with established… more
- STG International (Hopkinsville, KY)
- …in quality improvement, care management , risk management , peer review , utilization review , clinical outcomes, and health enhancement activates. ... Participate in the orientation of clinical staff physicians, physician assistants and nurse practitioners. + Provide leadership to CBOC clinicians. + Evaluate the… more
- Catholic Health Initiatives (Lexington, KY)
- …collecting data and running reports in the schedule software. Prepare data for management to present to stakeholders. The Coordinator is also responsible for time ... works to resolve customer conflicts and complaints. + Keep nurse managers informed of unfilled shifts and call-ins. +...staffing and prepares tentative staffing for clinical contact to review and approve. + Follows escalation procedures for day-… 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