- Molina Healthcare (Lexington, 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 (Georgetown, 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
- Cognizant (Frankfort, KY)
- …necessity determinations to the Health Plan/ Medical Director based on the review of clinical documentation in accordance with Medicare, Medicaid, and ... as well as timely filing deadlines and processes. . Review clinical denials including but not limited...thinking skills to interpret guidelines of internal policies for clinical determination. . Medical Necessity Reviews can… more
- Molina Healthcare (Lexington, KY)
- **JOB DESCRIPTION** **Job Summary** The Clinical Appeals Nurse (RN) provides support for internal appeals clinical processes - ensuring that appeals requests ... Central time Remote position **Essential Job Duties** * Performs clinical / medical reviews of previously denied cases in...specific programs supported by the plan such as utilization review , medical claims review , long-term… 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
- Veterans Affairs, Veterans Health Administration (Lexington, KY)
- …outlined in the clinical privileges that correspond with this position. The Nurse Practitioner has prescriptive authority for a panel of patients or program as ... determined by the VHA Education Loan Repayment Services program office after review of the EDRP application. Former EDRP participants ineligible to apply.… more
- Humana (Frankfort, KY)
- …community and help us put health first** The Utilization Management Behavioral Health Nurse 2 utilizes clinical nursing skills to support the coordination, ... determination of the appropriate courses of action. The Utilization Management Behavioral Health Nurse 2 completes medical record reviews from medical … 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
- 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
- CenterWell (Frankfort, KY)
- …complaints. + Makes clinical level of care determination based on discussion, medical records, and any other pertinent clinical data. Matches these needs to ... regarding Home Health, Hospice, and Palliative Care Services. + Assist with clinical eligibility review for alternate services + Participates in special… more
- Sedgwick (Frankfort, KY)
- … Consultant) Certification or training preferred. **Experience** Five (5) years related clinical nursing experience and two (2) years nurse consultant experience ... Fortune Best Workplaces in Financial Services & Insurance Professional Liability Nurse Consultant **PRIMARY PURPOSE** **:** To handle complex or high exposure… more
- Datavant (Frankfort, KY)
- …years of CDI experience + 3+ years of clinical experience in an academic medical center + Registered Nurse license, Bachelor's degree in Nursing + CCDS or ... realize our bold vision for healthcare. **What We're Looking For:** As a Clinical Documentation Quality Improvement (CDQI) Specialist, you will play a pivotal role… more
- Surgery Care Affiliates (Lexington, KY)
- …do it. Each decision we make is rooted in seven core values: + Clinical quality + Integrity + Service excellence + Teamwork + Accountability + Continuous improvement ... package to support your health, well-being, and financial future. Our offerings include medical , dental, and vision coverage, 401k plan with company match, paid time… 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
- CenterWell (Frankfort, KY)
- …will collaborate with other health care givers in reviewing actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review ... Compact Nursing License + A minimum of three years clinical RN experience; + Prior clinical experience,...Bilingual We offer tangible and intangible benefits such as medical , dental and vision benefits, 401k with company matching,… more
- CenterWell (Frankfort, KY)
- …will collaborate with other health care givers in reviewing actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review ... Compact Nursing License + A minimum of three years clinical RN experience; + Prior clinical experience,...extends outside of work. Among our benefits, Humana provides medical , dental and vision benefits, 401(k) retirement savings plan,… 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
- 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
- Molina Healthcare (Lexington, 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