- Molina Healthcare (Lexington, KY)
- JOB DESCRIPTION **Job Summary** The Care Review Clinician ( RN ) provides support for clinical member services review assessment processes. Responsible ... experience. Candidates with MCO experience are highly preferred. The Care Review Clinician must be...or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must… more
- Molina Healthcare (Owensboro, KY)
- JOB DESCRIPTION **Job Summary** The RN Care Review Clinician provides support for clinical member services review assessment processes. Responsible ... least 2 years experience, including experience in hospital acute care , inpatient review , prior authorization, managed ...or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must… more
- Molina Healthcare (Louisville, KY)
- …RN who must be licensed in KY or have a compact RN license. The Care Review Clinician Inpatient Review BH will provide prior authorization for ... For this position we are seeking a Licensed Masters Level social worker, counselor, therapist and/or RN with a current active license for state of KY or … more
- Molina Healthcare (Owensboro, 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 ... least 2 years experience, including experience in hospital acute care , inpatient review , prior authorization, managed ...or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must… more
- Molina Healthcare (Louisville, KY)
- For this position we are seeking a ( RN ) Registered Nurse who must be licensed for the state they reside This role will be doing Utilization review for ... least 2 years experience, including experience in hospital acute care , inpatient review , prior authorization, managed ...or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must… more
- Molina Healthcare (Louisville, KY)
- …managed care , or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted in ... unit (ICU) or emergency room. Previous experience in managed care Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG… more
- Molina Healthcare (Covington, KY)
- …managed care , or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted in ... JOB DESCRIPTION Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically… more
- Molina Healthcare (Owensboro, KY)
- …for internal meetings. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse ( RN ). **Required Experience** 1-3 years of ... clinic experience. **Required License, Certification, Association** Active, unrestricted State Registered Nursing ( RN ) license in good standing. **Preferred… more
- Highmark Health (Frankfort, KY)
- …of experience in Managed Care **LICENSES or CERTIFICATIONS** **Required** + Registered Nurse **Preferred** + Certified Medical Coder or related **SKILLS** + ... and the proper action to complete the retrospective claim review with the goal of proper and timely payment...outcomes. Will monitor and analyze the delivery of health care services in accordance with claims submitted, and analyzes… more
- Datavant (Frankfort, KY)
- …with clinical knowledge and expertise successfully. Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well versed in DRG downgrade ... government agencies, and those who deliver and pay for care . By joining Datavant today, you're stepping onto a...by management Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well… more
- HCA Healthcare (Bowling Green, KY)
- …Performance and ICARE values. **What qualifications you will need:** + Current licensure as a Registered Nurse ( RN ) in the state of Kentucky or compact state ... required. + 3 years of clinical experience as a Registered Nurse required. + Prior leadership experience...opportunity compelling, we encourage you to apply for our Nurse House Supervisor PRN opening. We promptly review… more
- Elevance Health (Louisville, KY)
- …in different states; therefore, Multi-State Licensure will be required.** The **Medical Management Nurse ** is responsible for review of the most complex or ... **Medical Management Nurse ** **Location: Virtual: This role enables associates to...and requires a minimum of 2 years clinical, utilization review , or managed care experience; or any… more
- Elevance Health (Louisville, KY)
- …employment, unless an accommodation is granted as required by law. The **Medical Management Nurse ** is responsible for review of the most complex or challenging ... **Medical Management Nurse ** **Hours: 8am-6pm flexible start time** **Location** :...not be receiving appropriate type, level, or quality of care , eg, if services are not in line with… more