- Evolent (Frankfort, KY)
- …scheduled. + Determines medical necessity and appropriateness of services using clinical review criteria. + Accurately documents all review ... for the mission. Stay for the culture. **What You'll Be Doing:** The Nurse Reviewer is responsible for performing precertification and prior approvals. Tasks… more
- Centene Corporation (Frankfort, KY)
- …be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, ... member's overall health, reviewing the type of care being delivered, evaluating medical necessity, and contributing to discharge planning according to care policies… more
- Molina Healthcare (Louisville, KY)
- …will work on set schedule) Looking for a RN with experience with appeals, claims review , and medical coding. **Job Summary** Provides support for medical ... and cost-effective member care. **ESSENTIAL JOB DUTIES:** + Facilitates clinical / medical reviews of retrospective medical ...nursing experience, including at least 1 year of utilization review , medical claims review , long-term… more
- Fresenius Medical Center (Louisville, KY)
- …or federal surveys. + Participates in the completion of the FMS Administrative Clinical Review . **PHYSICAL DEMANDS AND WORKING CONDITIONS:** + The physical ... requirements. Ensure provision of quality patient care while maintaining cost-effective clinical operations in accordance with all legal, compliance, and regulatory… more
- Elevance Health (Louisville, KY)
- ** Nurse Audit Senior - Payment Integrity Complex and Clinical Audit** **Location:** This role enables associates to work virtually full-time, with the exception ... formerly Payment Integrity, is determined to recover, eliminate and prevent unnecessary medical -expense spending. The ** Nurse Audit Senior** will be responsible… more
- Elevance Health (Louisville, KY)
- ** Clinical Fraud Investigator II - Registered Nurse and CPC - Calrelon Payment Integrity SIU** **Location:** This role requires associates to be in-office 1 - 2 ... Payment Integrity, is determined to recover, eliminate and prevent unnecessary medical -expense spending. The ** Clinical Fraud Investigator II** is responsible… more
- Humana (Frankfort, KY)
- …Manager, Fraud and Waste Investigator: Nurse Audit/ Review performs clinical audit/validation processes to ensure that medical record documentation and ... approach, resources, schedules and goals. The Manager, Fraud and Waste Investigator: Nurse Audit/ Review validates and interprets medical documentation to… more
- ChenMed (Louisville, KY)
- …JOB FUNCTIONS: The Nurse Practitioner (NP) acts as part of the clinical operations team and is responsible for providing direct patient care in ChenMed/Jencare ... This position may require to participate in risk and quality management programs, clinical meetings and other meetings. The Nurse Practitioner will adhere to… more
- ChenMed (Louisville, KY)
- …This position may require participation in risk and quality management programs, clinical meetings and other meetings. The Nurse Practitioner will adhere ... nurse practitioner role. + Facilitates patient/family conferences to review treatment goals, optimize resource utilization, provide family education and identify… more
- BrightSpring Health Services (Louisville, KY)
- …authorizations, and document all interactions with patients regarding medication adjustments. . Review and process clinical orders as needed, ensuring compliance ... Our Company Abode Care Partners Overview The Nurse Care Manger is an LPN who plays...crucial role in delivering patient-centered care by focusing on clinical assessments, care planning, and patient education. Working closely… more
- HCA Healthcare (Frankfort, KY)
- …is important to you, we encourage you to apply for our Labor and Delivery Nurse PRN opening. Our team will promptly review your application. Highly qualified ... to deliver excellent care patients deserve? At Frankfort Regional Medical Center we support our colleagues in their positions....positions. Join our Team as a(an) Labor and Delivery Nurse PRN and access programs to assist with every… more
- Humana (Frankfort, KY)
- …needs and by providing guidance along the healthcare continuum. You will perform clinical case review on members during an inpatient hospital admission. You ... us put health first** The NICU Care Manager, Telephonic Nurse 2, in a telephonic environment, assesses and evaluates...+ Bilingual is a plus - preferably Spanish + Clinical claim review experience **Additional Information** +… more
- HCA Healthcare (Frankfort, KY)
- …is important to you, we encourage you to apply for our Progressive Care Nurse opening. Our team will promptly review your application. Highly qualified ... to deliver excellent care patients deserve? At Frankfort Regional Medical Center we support our colleagues in their positions....their positions. Join our Team as a(an) Progressive Care Nurse and access programs to assist with every stage… more
- HCA Healthcare (Frankfort, KY)
- …$25,000 Sign-On Bonus Do you have the career opportunities as a(an) Step Down Nurse you want with your current employer? We have an exciting opportunity for you ... to join Frankfort Regional Medical Center which is part of the nation's leading...Do you want to work as a(an) Step Down Nurse where your passion for creating positive patient interactions… more
- Highmark Health (Frankfort, KY)
- …over a specified panel of members that range in health status/severity and clinical needs; and assesses health management needs of the assigned member panel and ... utilizing data/analytics in conjunction with professional clinical judgement to identify the right clinical intervention for each member. The incumbent conducts… more
- Veterans Affairs, Veterans Health Administration (Louisville, KY)
- …a primary care provider (MD, NP, PA), registered nurse care manager, clinical associate (LPN or medical assistant/ health technician) and an administrative ... range of medical clinicians across multiple disciplines (eg medical doctors, nurse practitioners, physician assistants, psychologists, psychiatrists, social… more
- Elevance Health (Louisville, KY)
- …Group Clinical Validation Auditor** is responsible for auditing inpatient medical records to ensure clinical documentation supports the conditions and ... DRGs billed and reimbursed. Specializes in review of Diagnosis Related Group (DRG) paid claims. **How...an impact:** + Analyzes and audits claims by integrating medical chart coding principles, clinical guidelines, and… more
- Cardinal Health (Frankfort, KY)
- …to ensure a positive and satisfactory experience for all customers. The Supervisor, Clinical Operations monitors nurse to patient contact quality and provides ... manufacturers to rethink the reach and impact of their products. The Supervisor, Clinical Operations provides management and clinical oversight to a team of… more
- Fujifilm (Frankfort, KY)
- **Position Overview** The Clinical Consultant, MI - I shall be responsible for providing clinical consulting for the project, report configuration (CV), workflow ... go-live support to Synapse PACS/MI projects. In addition, provide clinical support for sales and company team members with...HCUS team to gain customer acceptance of the FUJIFILM Medical Systems solution. + Participates in teaching and training… more
- Molina Healthcare (Louisville, KY)
- …records and other data in support of annual HEDIS project management and ongoing review of medical records submitted by providers. + Implements Molina Healthcare ... completion of any of the following programs: + Registered Nurse (RN) or State Licensed Vocational Nurse ... records collection and abstraction * 2+ years of medical record review experience **REQU** **I** **RED… more