- CVS Health (Frankfort, KY)
- …all with heart, each and every day. **Position Summary** Utilizes advanced clinical judgment and critical thinking skills to facilitate appropriate member physical ... health and behavioral healthcare through assessment and care planning, direct provider...or Company. **Required qualifications:** + 3 years of direct clinical practice experience post master's degree + Requires knowledge… more
- Molina Healthcare (Louisville, KY)
- …level of the assigned members, particular state-specific regulations, or whether the Case Manager position is located within Molina's Central Programs unit. ... per regulated timelines and determines who may qualify for case management based on clinical judgment, changes...Social Worker (LCSW), Advanced Practice Social Worker (APSW), Certified Case Manager (CCM), Certified in Health Education… more
- Molina Healthcare (Lexington, KY)
- …Management (CPHM), Certified Professional in Health Care Quality (CPHQ), Commission for Case Manager Certification (CCMC), Case Management Society of ... to provide quality and cost-effective member care. Essential Job Duties * Provides behavioral health oversight and clinical leadership for health plan and/or… more
- CVS Health (Frankfort, KY)
- …members. **Key Responsibilities** + This position consists of working intensely as a telephonic case manager with patients and their care team for fully and/or ... within Aetna/CVS Health. Founded in 1993, AHH is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical… more
- Elevance Health (Louisville, KY)
- …for clinical operational aspects of a program. + Conduct peer-to-peer clinical appeal case reviews with attending physicians or other ordering providers ... ** Behavioral Health Medical** **Director-Psychiatrist** **Appeals** **Location:** This role...manager . + May be responsible for an entire clinical program and/or independently performs clinical reviews.… more
- Catholic Health Initiatives (Lexington, KY)
- …and Responsibilities** **Job Summary / Purpose** Coordinates a system of direct case management to effectively follow patients throughout the continuum of care in ... planning functions, and monitoring of quality of service throughout the case management process. Performs direct Interqual/M&R utilization review on all acute… more
- Molina Healthcare (Lexington, KY)
- …to navigate online portals and databases. **Preferred Qualifications** + Certified Case Manager (CCM), Certified Professional in Healthcare Management (CPHM), ... **Required Qualifications** + At least 5 years of health care experience, including experience in clinical operations, and at least 3 or more years in one or more of… more
- Molina Healthcare (Louisville, 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
- Centene Corporation (Frankfort, KY)
- …correctional facilities. (about 75%)** **Willingness to work in secure settings.** ** Behavioral Health and Physical Health Experience** ** Case management ... correctional facilities. (about 75%)** **Willingness to work in secure settings.** ** Behavioral Health and Physical Health Experience** ** Case management… more
- Molina Healthcare (Lexington, KY)
- …be required (dependent upon state/contractual requirements). Preferred Qualifications * Certified Case Manager (CCM), Licensed Vocational Nurse (LVN) or Licensed ... suggest changes accordingly. * Promotes integration of services for members including behavioral health care and long-term services and supports (LTSS) and home and… more
- Molina Healthcare (Lexington, KY)
- …to navigate online portals and databases. Preferred Qualifications * Certified Case Manager (CCM), Certified Professional in Healthcare Management (CPHM), ... Required Qualifications * At least 5 years of health care experience, including experience in clinical operations, and at least 3 or more years in one or more of the… more
- Highmark Health (Frankfort, KY)
- …industry, corporate, state, and federal law standards and are within the care manager 's professional discipline. + For assigned case load, create care plans ... Nursing **EXPERIENCE** **Required** + 7 years in any combination of clinical , case /utilization management and/or disease/condition management experience, or… more
- CenterWell (Frankfort, KY)
- …and work is assisted by diverse resources which may include national clinical guidelines, CMS policies and determinations, clinical reference materials, internal ... Director's work includes computer-based review of moderately complex to complex clinical scenarios, review of all submitted clinical records, prioritization… more
- Sharecare (Frankfort, KY)
- …helps to drive cost effective and appropriate resource utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during their ... A Disease Management Nurse is supervised by an Operations Manager (OM). All Sharecare clinicians are required to participate...during the training period will be evaluated on a case by case basis and must be… more
- HCA Healthcare (Frankfort, KY)
- …to deliver clinical excellence behind the scenes in data science, case management or transfer centers. Unlock your potential at Frankfort Regional Medical ... for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services...and special projects as assigned by the RN, Nurse Manager or Director. What qualifications you will need: +… more