- Humana (Frankfort, KY)
- …help us put health first** Humana Healthy Horizons in Kentucky is seeking a Utilization Management Behavioral Health Professional 2 who utilizes ... and communication of medical services and/or benefit administration determinations. The Utilization Management Behavioral Health Professional… more
- Humana (Frankfort, KY)
- …Expertise on NCQA accreditation standards, especially related to Utilization Management and/or Behavioral Health ; MED-Deeming accreditation standards ... degree. + Minimum 3 years of experience in NCQA Health Plan Accreditation and/or Utilization Management...knowledge is a plus. + Registered Nurse or Behavioral Health Licensed Professional. + Managed care,… more
- Molina Healthcare (Bowling Green, KY)
- …& ABILITIES** : + 2 or more years in case, disease or utilization management ; managed care; or medical/ behavioral health settings. + One year of training ... EXPERIENCE** : 5 or more years in case, disease or utilization management ; managed care; or medical/ behavioral health settings. **PREFERRED LICENSE,… more
- Humana (Frankfort, KY)
- …part of our caring community and help us put health first** The Senior Utilization Management Behavioral Health Professional utilizes behavioral ... and communication of medical services and/or benefit administration determinations. The Senior Utilization Management Behavioral Health Professional work… more
- Evolent (Frankfort, KY)
- …the mission. Stay for the culture. **What You'll Be Doing:** The **Coordinator, Intake Utilization Management ** at Evolent will serve as a point of contact for ... and client contractual agreements. **Collaboration Opportunities** : The Coordinator, Intake Utilization Management reports directly to the Manager, … 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 ... 8:30am - 5pm within time zone of residence.** American Health Holding, Inc (AHH) is a medical management...states - 1+ years' current or previous experience in Behavioral Health - 1+ years' experience documenting… more
- Molina Healthcare (Covington, 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)
- …equivalent experience * 2 or more years in case, disease, or utilization management ; managed care; or medical/ behavioral health settings. * Proficient in ... development, implementation, and collaboration with the delivery of training curriculum for Utilization Management , Case Management , and LTSS staff. **Job… more
- Molina Healthcare (Louisville, KY)
- …State Registered Nursing (RN) license in good standing. + Utilization Management Certification (CPHM) Certified Professional in Health Care Quality (CPHQ), ... an integrated delivery of care across the continuum, including behavioral health and long-term care, for members...in implementation and compliance to AVP, VP and senior management . + Consultative role, develops business case methodologies for… 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...clinical care is being provided. **Preferred** + Certification in utilization management or a related field +… more
- Highmark Health (Frankfort, KY)
- …timeframes and notification requirements are met + Communicate effectively with Utilization Management Staff, providers, other internal and external customers ... processing of pre-certification requests for authorization of medically necessary health care services at the appropriate level of care,...and management + Route Cases Based on Established Guidelines +… more
- Highmark Health (Frankfort, KY)
- …(Claims, Dental Benefits, Customer Service, Membership & Billing), Provider Data Management , Underwriting, and Professional Relations. **This role will support the ... including gathering data from multiple sources related to Benefit/Claim Utilization , Enrollment, Networks ( utilization , disruption, geo-access) and making… more
- CVS Health (Bowling Green, 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
- Elevance Health (Louisville, KY)
- …A proud member of the Elevance Health family of companies, Carelon Behavioral Health , formerly Beacon Health Options, offers superior clinical mental ... preferred. + Extensive orthopedic surgery experience preferred. + Experience with utilization management , especially with CMS guidelines preferred. For… 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 ... and overseeing clinical/non-clinical activities. Will also be responsible for utilization review/ management . May be responsible for developing and… more
- HCA Healthcare (Bowling Green, KY)
- …services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed ... organization that invests in you as a(an) Director Case Management ? At TriStar Greenview Regional Hospital, you come first....Hospital, offers a total rewards package that supports the health , life, career and retirement of our colleagues. The… more
- Cumberland River Behavioral Health, Inc. (Manchester, KY)
- …well with people of all races, backgrounds and needs + Knowledgeable of Behavioral Health concepts and how to incorporate concepts into practical application ... of psychiatric rehabilitation, effective listening and communication skills, diagnosis and medication management , management of mental health disorders or… more
- Elevance Health (Louisville, KY)
- …evaluation, coordination and management of members needs, including physical health , behavioral health , social services and community services ... the health care team, to ensure cost effective and efficient utilization of health benefits. + Decision making skills will be based upon the current needs… more
- Highmark Health (Frankfort, KY)
- …with strong analytical and communication skills. **ESSENTIAL RESPONSIBILITIES** + Perform management responsibilities to include, but are not limited to: involved in ... termination decisions, coaching and development, rewards and recognition, performance management and staff productivity.Plan, organize, staff, direct and control the… more