- 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 ... action. + Minimum one, (1) year of experience in Behavioral Health Nursing (inpatient outpatient, psych, substance...Nursing experience + Previous experience in utilization management with ASAM knowledge + Health Plan… 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
- 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
- CenterWell (Frankfort, KY)
- …UM Administration Coordinator - Phone Intake contributes to administration of utilization management . The UM Administration Coordinator performs varied ... best care, when needed most, and for the lowest cost. We go beyond physical health - addressing the social, emotional, behavioral and financial needs that can… 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 (Covington, 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
- 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
- Elevance Health (KY)
- …patients, patients with IDD and patients with special needs is preferred. + Home Health , Utilization Management or Case Management experience strongly ... care plans by educating members regarding clinical needs and facilitating referrals to health professionals for behavioral health needs. + Uses motivational… 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 (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
- CVS Health (Henderson, 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
- 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
- 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
- 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
- Highmark Health (Frankfort, KY)
- …and leadership from more senior Delivery Owners. The incumbent provides project management leadership and facilitates the delivery of system changes from approval ... through to release to production. The leadership provided includes all project management outputs as well as extensive communication with business stakeholders both… more
- CenterWell (Louisville, 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 ... part of our caring community and help us put health first** The Market CMO serves as a ...expertise. + Develop, implement and monitor the outcomes of utilization review and disease management programs to… 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