- Humana (Frankfort, KY)
- …part of our caring community and help us put health first** The SNF Utilization Management Nurse uses clinical knowledge, communication skills, and ... receives guidance where needed. Follows established guidelines and procedures. The SNF Utilization Management Nurse uses clinical knowledge, communication… more
- CVS Health (Frankfort, KY)
- …Must have active current and unrestricted RN licensure in state of residence. + Utilization Management is a 24/7 operation and work schedules will include ... med surg or specialty area. + Managed Care experience preferred, especially Utilization Management . + Preference for those residing in EST and CST zones.… more
- Humana (Frankfort, KY)
- …a part of our caring community and help us put health first** The Utilization Management (UM) Director, Clinical Strategy and Practice for Medicaid builds ... of how organization capabilities interrelate across the function or segment. The Utilization Management (UM) Director, Clinical Strategy and Practice for… more
- CVS Health (Frankfort, KY)
- …SEE REQUIRED QUALIFICATIONS FOR LICENSING DETAILS_** This is a fulltime remote Utilization Management Clinical Consultant opportunity with Aetna Better Health of ... clinical skills to coordinate, document and communicate all aspects of the utilization /benefit management program. + Applies critical thinking and is… more
- Zurich NA (Frankfort, KY)
- …+ Experience in development and implementation of cost containment programs + Case management , utilization review, catastrophic or disability experience + 5 or ... AVP, Utilization Review & Pharmacy 123092 Zurich Insurance is...recruiting and retaining team members. + Drive the performance management process by communicating job expectations, monitoring and evaluating… more
- Humana (Frankfort, KY)
- …us put health first** Humana Healthy Horizons in Kentucky is seeking a Utilization Management Behavioral Health Professional 2 who utilizes behavioral health ... and communication of medical services and/or benefit administration determinations. The Utilization Management Behavioral Health Professional 2 work assignments… more
- Veterans Affairs, Veterans Health Administration (Lexington, KY)
- Summary The Registered Nurse Transfer coordinator is directly responsible for the facilitation and monitoring of the community hospital referrals to the VA facility, ... for collaborating with other staff for appropriate oversight and management of emergency care received through community hospitals. Responsibilities Duties… more
- CVS Health (Frankfort, KY)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... **Oncology or Specialty Pharmacy** **.** **Preferred Qualifications** + 1+ years' Case Management experience or discharge planning, nurse navigator or nurse… more
- HCA Healthcare (Frankfort, KY)
- …effective labor management , including position control, scheduling excellence, productivity management , and premium pay utilization to maintain staffing to ... United Kingdom. We are looking for a Critical Care Nurse Director for our Frankfort Regional Medical Center team...the effectiveness on an ongoing basis. + Implement Emergency Management Plan and Patient Safety Initiatives. + Coordinate the… more
- Evolent (Frankfort, KY)
- …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and client policies and ... the culture. **What You'll Be Doing:** The Evolent Appeals Nurse team offers candidates the opportunity to make a...and regulations. * Practices and maintains the principles of utilization management and appeals management … more
- Molina Healthcare (Lexington, KY)
- …Chief Medical Officer on denial decisions. + Resolves escalated complaints regarding Utilization Management and Long-Term Services & Supports issues. + ... as may be required. + Serves as a clinical resource for Utilization Management , Chief Medical Officer, Physicians, and Member/Provider Inquiries/Appeals. +… more
- Sharecare (Frankfort, KY)
- …total healthcare management and ensure cost effective, appropriate resource utilization and quality outcomes. The Clinical Registered Nurse is also ... the participants and their Primary Care Provider according to the disease management program intervention guidelines. A Clinical Registered Nurse is supervised… more
- Highmark Health (Frankfort, KY)
- …Nursing **EXPERIENCE** **Required** + 7 years in any combination of clinical, case/ utilization management and/or disease/condition management experience, or ... on where clinical care is being provided. **Preferred** + Certification in utilization management or a related field + Certification in Case Management … more
- Evolent (Frankfort, KY)
- …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and ... **What You Will Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to company policies and… more
- Fresenius Medical Center (Lexington, KY)
- …Classification of Disease (ICD) coding. + Manages clinic financials including efficient utilization of supplies or equipment and regular profits and loss review. + ... + Preferred but not required: + 3+ years supervisory or project/program management experience. + Med/surg or ICU/CCU experience. **PHYSICAL DEMANDS AND WORKING… more
- United Therapeutics (Frankfort, KY)
- …for which transplant is not currently an option. Who you are You are experienced nurse and an expert in all things PAH. You love providing mentorship, coaching and ... make a difference. The Regional Field Director, RNS Program Management serves as a director of all clinical field...+ Plan, collaborate, create and produce the yearly Clinical Nurse Summit meeting for HCPS across the United States… more
- Molina Healthcare (Lexington, 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
- Humana (Frankfort, KY)
- …**Key Functions:** **Strategic Planning and Implementation:** + Develop and implement utilization management strategies that align with organizational goals. + ... care. **Cost Containment:** + Identify opportunities for cost savings through effective utilization management practices. + Monitor and analyze utilization … more
- CVS Health (Frankfort, KY)
- …all with heart, each and every day. Job Description: The Care Management Associate supports comprehensive coordination of medical services including Care Team ... supporting the implementation of care plans to promote effective utilization of healthcare services. Promotes/supports quality effectiveness of Healthcare Services.… more
- CenterWell (Lexington, KY)
- …driver's license, auto insurance and reliable transportation. + Two years as a Registered Nurse with at least one-year of management experience in a home care, ... review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and conducts… more