- 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 ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...make an impact** + Active Florida license or Compact Registered Nurse Clinical license without restrictions. +… 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 ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...skills to make an impact** **Required Qualifications** + Licensed Registered Nurse ( RN ) in the… more
- CVS Health (Frankfort, KY)
- …active current and unrestricted RN licensure in state of residence. + Utilization Management is a 24/7 operation and work schedules will include weekends, ... **Required Qualifications** + 2+ years of experience as a Registered Nurse in adult acute care/critical care...or specialty area. + Managed Care experience preferred, especially Utilization Management . + Preference for those residing… more
- Humana (Frankfort, KY)
- …of our caring community and help us put health first** The Senior Compliance Nurse reviews utilization management activities and documentation to ensure ... your skills to make an impact** **Required Qualifications:** + Registered Nurse with a Bachelor's degree in...action + Minimum two, (2) years of experience in utilization management + Intermediate proficiency using Microsoft… more
- AdventHealth (Manchester, KY)
- …or Clay County depending on RN . **The role you'll contribute:** The Home Health Registered Nurse ( RN ) Care Manager is a professional nurse who ... and directs the home care patient's care based on individual patient needs. The RN Care Manager is responsible for independent management of the Home Health… 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
- 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. + ... of education and experience. + Graduate of an accredited School of Nursing ( RN ). + Current appropriate state licensure. **EXPERIENCE AND SKILLS:** + Required: + 6+… more
- Bon Secours Mercy Health (Paducah, KY)
- …partnership * Interprofessional collaboration and leadership * Understanding and utilization of office and clinical technologies * Compassionate, relationship-based ... for professional actions * Effective stewardship of available resources * Conflict management and resilience * Authority for delegating activities to others, while… more
- Sharecare (Frankfort, KY)
- …cost effective, appropriate resource utilization and quality outcomes. The Clinical Registered Nurse is also responsible for early identification of those ... according to the disease management program intervention guidelines. A Clinical Registered Nurse is supervised by an Operations Manager (OM). All Sharecare… more
- CVS Health (Frankfort, KY)
- …care. + Perform medical necessity reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse ( RN ) with at least 1 year of experience ... is URAC accredited in Case Management , Disease Management and Utilization Management . AHH...in a hospital setting. + A Registered Nurse that holds an active, unrestricted… more
- Jennie Stuart Medical Center, Inc. (Hopkinsville, KY)
- The RN working in L/D is responsible for promoting...be licensed by the state of Kentucky as a Registered Nurse , as well as NRP/BLS/ACLS certified. ... conducting medical screens on patients presenting to L/D for monitoring/observation. The RN has knowledge of the admission, discharge, transfer and fetal monitoring… 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 ... reviews **Required Qualifications** - 5+ years' experience as a Registered Nurse with at least 1 year...using a keyboard **Preferred Qualifications** - 1+ years' Case Management experience or discharge planning, nurse navigator… more
- CenterWell (Frankfort, KY)
- …a part of our caring community and help us put health first** The Compliance Nurse 2 reviews utilization management activities and documentation to ensure ... RN license in the state(s) in which the nurse is required to practice + Ability to be...experience a plus + Previous experience in chronic disease management , utilization management , case … more
- Molina Healthcare (Bowling Green, KY)
- …knowledge on the job. Job Qualifications **REQUIRED EDUCATION** : Completion of an accredited Registered Nurse ( RN ) Program and an Associate's or Bachelor's ... RN , LVN, or bachelor's trained candidates with a strong background in Utilization Management . Additionally, the applicant should have proven experience as a… more
- Humana (Frankfort, KY)
- …Family Therapist **(LMFT)** , Licensed Professional Counselor **(LPC)** , Psychologist **(PhD)** , Registered Nurse **( RN )** or other professional license. + ... health first** Humana Healthy Horizons in Kentucky is seeking a Utilization Management Behavioral Health Professional 2 who utilizes behavioral health knowledge… 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 ... required depending on where clinical care is being provided. **Preferred** + Certification in utilization management or a related field + Certification in Case … more
- Humana (Frankfort, KY)
- …+ Minimum 3 years of experience in NCQA Health Plan Accreditation and/or Utilization Management + Exceptional attention to detail. + Demonstrated excellent time ... + Expertise on NCQA accreditation standards, especially related to Utilization Management and/or Behavioral Health; MED-Deeming accreditation standards… more
- CenterWell (Louisville, KY)
- …license, auto insurance and reliable transportation. + Two years as a Registered Nurse with at least one-year of management experience in a home care, ... clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates...School of Nursing. + Current state license as a Registered Nurse . + Proof of current CPR.… more
- Molina Healthcare (Bowling Green, KY)
- …for internal meetings. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse ( RN ). **Required Experience** 1-3 years of ... **JOB DESCRIPTION** Opportunity for experienced Utilization Review RN in United States...transplants; the ideal candidate will have experience either in utilization review or case management for transplants.… more
- Molina Healthcare (Covington, KY)
- …**JOB QUALIFICATIONS** **Required Education** Any of the following: Completion of an accredited Registered Nurse ( RN ), Licensed Vocational Nurse (LVN) ... medical clinic experience. **Required License, Certification, Association** Active, unrestricted State Registered Nursing ( RN ), Licensed Vocational Nurse … more