- 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
- 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
- CVS Health (Frankfort, KY)
- …health clinician with Kentucky state licensure (LCSW, LPCC, LMFT, LPAT) or a Registered Nurse (RN) with active current and unrestricted Kentucky state license ... and external constituents in the coordination and administration of the utilization /benefit management function. + Utilizes clinical skills to coordinate,… 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 ... + Perform medical necessity reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse with at least 1 year of experience in a hospital… more
- Fresenius Medical Center (Georgetown, 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
- Molina Healthcare (Lexington, KY)
- …ensure appropriate reimbursement to providers. + Resolves escalated complaints regarding utilization management and long-term services and supports (LTSS) ... modification of payment decisions. + Serves as a clinical resource for utilization management , CMOs, physicians and member/provider inquiries/appeals. + Provides… more
- Evolent (Frankfort, KY)
- …+ Performs other duties as assigned. **The Experience You'll Need (Required):** + Registered Nurse or Licensed Practical/Vocational Nurse with a current, ... Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. Tasks are performed… more
- Molina Healthcare (Lexington, KY)
- JOB DESCRIPTION For this position we are seeking a (RN) Registered Nurse and/or a Licensed Social Worker who lives in Kentucky and must be licensed for the state ... in some or all of the following functions: care management , utilization management , behavioral health,...r equivalent combination of relevant education and experience. * Registered Nurse (RN), Licensed Vocational Nurse… more
- Molina Healthcare (Lexington, KY)
- …with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications * At ... or equivalent combination of relevant education and experience. * Registered Nurse (RN). License must be active...emergency room. Previous experience in managed care Prior Auth, Utilization Review / Utilization Management … more
- Molina Healthcare (Lexington, KY)
- …at least 3 or more years in one or more of the following areas: utilization management , care management , care transitions, behavioral health, or equivalent ... external vendors. * Focuses on process improvement, organizational change management , program management and other processes relative...combination of relevant education and experience. * Registered Nurse (RN), Licensed Vocational … more
- Molina Healthcare (Lexington, KY)
- For this position we are seeking a (RN) Registered Nurse who must hold a compact license. This is a Remote position, home office with internet connectivity of ... to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required...or equivalent combination of relevant education and experience. * Registered Nurse (RN). License must be active… more
- Highmark Health (Frankfort, KY)
- …and education or if necessary involve Special Investigation Unit or the Utilization Management area. **ESSENTIAL RESPONSIBILITIES** + Implement the pre-payment ... data to assure appropriate level of payment and resource utilization . It is also used to identify issues which...experience in Managed Care **LICENSES or CERTIFICATIONS** **Required** + Registered Nurse **Preferred** + Certified Medical Coder… more