- ChenMed (Louisville, KY)
- …physical exam, diagnosis and treatment, development of the plan of care, health education, specialty referrals, case management referrals, follow-up and clear ... make informed decisions re: goals of care, palliative care and hospice. Utilization /Financial Management -managing resource utilization and reimbursement for… more
- Humana (Frankfort, KY)
- …a part of our caring community and help us put health first** The Utilization Management Behavioral Health Professional 2 utilizes behavioral ... and communication of medical services and/or benefit administration determinations. The Utilization Management Behavioral Health Professional… more
- CVS Health (KY)
- …clinically appropriate treatment, evidence based care and clinical practice guidelines for Behavioral Health and/or medical conditions based upon program focus. ... ambulatory care or outpatient clinic/facility. + Valid unrestricted independent professional behavioral health clinical license to practice per state regulations… more
- CVS Health (KY)
- …clinically appropriate treatment, evidence-based care and clinical practice guidelines for Behavioral Health and/or medical conditions based upon program focus. ... + Must reside in Kentucky or bordering Counties + Licensed independent behavioral health clinician with Kentucky state licensure (LCSW, LPCC, LMFT,… more
- Molina Healthcare (Covington, KY)
- …chemical dependency services - working closely with regional medical directors to standardize behavioral health utilization management policies and ... and clinical leadership for health plan and/or market specific utilization management and care management behavioral health programs and… more
- Molina Healthcare (Louisville, KY)
- …licensing mandate. + At least 2 years in case, disease or utilization management ; managed care; or medical/ behavioral health settings. + One year of ... Social Worker/Counseling License. + Certified Case Manager (CCM), Utilization Management Certification (CPHM), Certified Professional in Health Care Quality,… more
- Centene Corporation (Frankfort, KY)
- …and standards. **This is a remote position.** **Ideal candidates will have experience in behavioral health utilization review and ability to work in Eastern ... million members as a clinical professional on our Medical Management / Health Services team. Centene is a diversified,...regulatory guidelines and criteria + Performs concurrent review of behavioral health (BH) inpatient to determine overall… more
- Molina Healthcare (Lexington, KY)
- …program(s) proficiency. Preferred Qualifications * Utilization management , care management , behavioral health and/or long-term services and supports ... * At least 2 years health care experience, preferably in utilization management , care management , and/or managed care, or equivalent combination of… more
- Molina Healthcare (Owensboro, KY)
- …with implementing integrated Behavioral Health care management programs. **Knowledge/Skills/Abilities** Provides Psychiatric leadership for utilization ... **JOB DESCRIPTION** **Job Summary** Molina's Behavioral Health function provides leadership and... Health function provides leadership and guidance for utilization management and case management … more
- Molina Healthcare (Bowling Green, KY)
- …**_Field travel in Detroit, MI_** **Job Summary** Molina's Behavioral Health function provides leadership and guidance for utilization management ... health and substance use services and assists with implementing integrated Behavioral Health care management programs. **Job Duties** * Serves as liaison… more
- Molina Healthcare (Louisville, KY)
- …or more of the following areas: utilization management , care management , care transitions, behavioral health , or equivalent combination of relevant ... Management (CPHM), Certified Professional in Healthcare Quality (CPHQ), or other health care or management certification. + Leadership experience. +… more
- Highmark Health (Frankfort, KY)
- …of clinical, case/ utilization management and/or disease/condition management experience, or provider operations and/or health insurance experience ... health status/severity and clinical needs; and assesses health management needs of the assigned member...first 6 months of employment. **Preferred** + Certification in utilization management or a related field +… more
- CVS Health (Frankfort, KY)
- …data from all care partners to holistically address all physical and behavioral health conditions including co-morbid and multiple diagnoses that impact ... Care and juvenile justice systems, Adoption Assistance, the delivery of Behavioral Health Services, Trauma-informed Care, ACEs, Crisis Intervention services,… more
- Sharecare (Frankfort, KY)
- …members to become empowered and active participants in their own healthcare management for their chronic condition. By providing health education and ... **Job Description:** Sharecare is the leading digital health company that helps people - no matter...nurse helps to drive cost effective and appropriate resource utilization and desired clinical outcomes. The Disease Management… more
- Magellan Health Services (Fort Campbell, KY)
- …and wellness presentations, and consultation to the assigned brigade/regiments command regarding behavioral health issues with a unique understanding of the ... - Required Clinical Work Experience - Preferred Education - Required Master's - Behavioral Health , Master's - Social Work Education - Preferred License and… more
- Highmark Health (Frankfort, KY)
- …:** **JOB SUMMARY** This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and ... (DO) **Substitutions** + None **Preferred** + Master's Degree in Business Administration/ Management or Public Health **EXPERIENCE** **Required** + 5 years… more
- Elevance Health (Louisville, KY)
- …an equivalent background. + For Health Solutions and Carelon organizations (including behavioral health ) only, minimum of 5 years of experience providing ... be part of the Central Region team responsible for utilization review case management and appeals for...directs, and implements clinical and non-clinical activities that impact health care quality cost and outcomes. + Identifies and… more
- Sevita (Somerset, KY)
- …elders with complex medical or rehabilitative needs, attendant care and case management . This allows seniors to obtain quality healthcare while remaining active and ... person we serve. **Remote must live in the state of Kentucky** **Operations Management Area Director** Everybody needs a job but only extraordinary people work here.… more
- Highmark Health (Frankfort, KY)
- **Company :** Highmark Health **Job Description :** **JOB SUMMARY** This job plays a key role in ensuring projects (ie change initiatives) meet objectives on time ... and minimize risk to implementation. Works to drive faster adoption, higher ultimate utilization and greater proficiency of the changes that impact employees in the… more
- Highmark Health (Frankfort, KY)
- **Company :** Highmark Health **Job Description :** **JOB SUMMARY** This role is responsible for designing, developing, implementing, supporting, and optimizing ... solutions, networks, and infrastructure. Ensure optimal technology selection, resource utilization , and seamless integration. + Utilize modeling tools to develop… more
