- CVS Health (Frankfort, KY)
- …or alternative care setting such as ambulatory care or outpatient clinic/facility. Unencumbered Behavioral Health clinical license in the state where they work. ... external constituents in the coordination and administration of the utilization /benefit management function Required Qualifications 3 years...LMSW, LSW, LISW, LMFT, LMHC, LCSW) OR RN with behavioral health experience required. Must be able… more
- Humana (Frankfort, KY)
- …such as provider relations, claims submission and payment, utilization management processes, behavioral health processes, and dispute resolution. ... part of our caring community and help us put health first** Humana Healthy Horizons is seeking a Senior...educational material, or trainings. + 2+ years of project management experience with mid-size projects. + 1+ years of… more
- CVS Health (Frankfort, KY)
- …/benefit management program. Required Qualifications : + Licensed independent Behavioral Health clinician with Kentucky state licensure (LCSW, LPCC, LMFT ... + Managed care/ utilization review experience preferred + Experience in a behavioral health inpatient setting + Ability to multitask, prioritize and… more
- Conviva (Frankfort, KY)
- …to others. Preferred Locations: Daytona, FL, Louisville, KY, San Antonio, TX The Utilization Management Nurse utilizes clinical nursing skills to support the ... and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse work assignments are varied and frequently… more
- Humana (Frankfort, KY)
- …teams focusing on quality management , utilization management , case management , discharge planning and/or home health or post acute services such as ... part of our caring community and help us put health first** The Behavioral Health ...health insurance, other healthcare providers, clinical group practice management . + Utilization management experience… more
- Humana (Frankfort, KY)
- …put health first** This is a non-exempt position with responsibility for utilization management and clinical decision-making as outlined in the Autism Care ... and receives guidance where needed. Follows established guidelines / procedures, utilizes behavioral health knowledge and skills to support the coordination,… more
- Elevance Health (Louisville, KY)
- **Manager Behavioral Health Clinical Services** **Location:** This position will work in a hybrid model (remote and office). The ideal candidate must live within ... 50 miles of an Elevance Health PulsePoint location. **Work schedule:** M-F normal business hours....clinical operations department. Manages the delivery of quality care management , clinical utilization , and referral services. **How… more
- Humana (Frankfort, KY)
- …resolve basic technical difficulties in a remote environment. **Preferred Qualifications** + BSN + Behavioral Health Utilization Management + Health ... us put health first** The Compliance Nurse 2 reviews utilization management activities and documentation to ensure adherence to policies, procedures, and… more
- Universal Health Services (Radcliff, KY)
- Responsibilities Utilization Review Coordinator Opportunity Lincoln Trail Behavioral Health System is a 140-bed hospital offering inpatient services for ... adolescents, adults, military/veterans and their families. Lincoln Trail Behavioral Health System has a spacious cafeteria,...Degree in Social Work or Psychology + Experience in Utilization Management preferred + Current CPR or… more
- BrightSpring Health Services (Louisville, KY)
- … utilization and hospital admission reduction. + Provides survey management support/ follow-up/and coordination of corrective actions plans relatied to care ... home health care, + Three years' experience in an administrative/supervisory/quality management role in a Medicare certified home health agency generally… more
- CVS Health (Frankfort, KY)
- …for Aetna. Health Services strategies, policies, and programs are comprised of utilization management , quality management , network management and ... on interventions to improve outcomes. Required Qualifications * 2 years' experience in behavioral health , social services, or human services field.* 1 year… more
- CenterWell (Frankfort, KY)
- …that impact patient well-being. Our integrated care teams, which include physicians, nurses, behavioral health specialists and more, spend up to 50 percent more ... Coordinate quality improvement activities to address high risk, high-utilizers/high-cost patient management through the utilization of the 5M's framework as… more
- Highmark Health (Frankfort, KY)
- …account, and member educational initiatives that promote the Organization's Formularies, utilization management programs, and case/ disease management ... information to improve individual outcomes as an adjunct to health coaching. If acting in the capacity as a...review. + Assist in the development and implementation of utilization management programs including but not limited… more
- CVS Health (Frankfort, KY)
- …care management activities with members to ensure that their medical and behavioral health needs are met and to enhance the member's overall wellness. ... + Using advanced clinical skills, performs crisis intervention with members experiencing a behavioral health or medical crisis and refers them to the appropriate… more
- BrightSpring Health Services (Louisville, KY)
- Our Company BrightSpring Health Services Overview Director of Clinical Denials Management and Audit supervises a team of RN/LPN clinical reviewers as well as ... or occupational therapy from an accredited or approved school.* Two years of experience in health care utilization review or home care.* Two years prior home … more
- Elevance Health (Louisville, KY)
- …PST.** The **Medical Director** is responsible for the administration of physical and/or behavioral health medical services, to ensure the appropriate and most ... For Health Solutions and Carelon organizations (including behavioral health ) only, a minimum of 5...a State agency. **Preferred Skills, Capabilities, and Experiences:** + Utilization Management experience is a plus. +… more
- Universal Health Services (Louisville, KY)
- …employees and through its subsidiaries operates 26 acute care hospitals, 327 behavioral health facilities, 40 outpatient facilities and ambulatory care access ... set the standard for excellence in the field of behavioral health care and will maintain its...a registered trademark of UHS of Delaware, Inc., the management company for Universal Health Services, Inc.… more
- Universal Health Services (Lexington, KY)
- …Counseling, as well as Medication Management for all ages. We have provided behavioral health services to over 92 Kentucky counties for more than 39 years. ... to meet the needs of our community. The Ridge Behavioral Health System is a 110-bed hospital...treatment through treatment planning, the treatment team process, and utilization and review. + Conduct psychosocial assessments. + Assess,… more
- Universal Health Services (Louisville, KY)
- …Brook Hospital will strive to set the standard for excellence in the field of behavioral health care and will maintain its leadership role by treating each ... is one of the nation's largest and most respected health care management companies, operating through its... companies, operating through its subsidiaries acute care hospitals, behavioral health facilities and ambulatory care centers… 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