- Humana (Frankfort, KY)
- …community and help us put health first** Full-Time, Remote Telephonic opportunity The Utilization Management Nurse 2 utilizes clinical nursing skills to ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...appropriate courses of action. As a Utilization Management RN working on the OneHome/ Home Solutions… 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 ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- ChenMed (Louisville, KY)
- … management programs, clinical meetings and other meetings. The Nurse Practitioner will adhere to strict departmental goals/objectives, standards of performance, ... we need great people to join our team. The Nurse Practitioner (NP) acts as part of the clinical...medical centers, nursing homes, skilled nursing facilities (SNF) and home settings depending on the nature of the assignment… more
- CVS Health (KY)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... Abuse or Maternity/ Obstetrics experience. **Preferred Qualifications** + 1+ years' Case Management experience or discharge planning, nurse navigator or nurse… more
- CenterWell (Frankfort, KY)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and ... **Required Qualifications** + Must be a licensed Registered Compact Nurse license (RN) with no disciplinary action and ability...volume and fast paced environment + Previous experience in utilization management + Education: BSN or bachelor's… more
- Molina Healthcare (Bowling Green, KY)
- …(EMR) experience. Preferred Qualifications * Experience as a registered nurse or nurse practitioner in a home health, community health or public health ... in home health as a licensed clinician, especially in management of chronic conditions. * Experience with underserved populations facing socioeconomic barriers… more
- Evolent (Frankfort, KY)
- …Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. Tasks are performed ... medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care across the continuum… more
- Evolent (Frankfort, KY)
- …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and ... Be Doing:** + Practices and maintains the principles of utilization management and appeals management ...all employees have the following technical capability at their home : High speed internet over 10 Mbps and, specifically… more
- Evolent (Frankfort, KY)
- …responsible for support and assistance for all cardiology administrative and clinical utilization management and quality improvement functions under the auspices ... NCH has business OTHER SKILLS and ABILITIES: Strong clinical, management , communication, and organizational skills. Demonstrated leadership skills Analytic skills… more
- Fresenius Medical Center (Georgetown, KY)
- …and acting on adverse events and action thresholds. + Oversees facility's Home Therapies Program if applicable. + Accountable for compliance with all applicable ... and acts as the liaison for patient care as per the disease management agreement, including initial and ongoing validation of member eligibility. Facilitate timely… more
- Fresenius Medical Center (Cadiz, KY)
- …Quality, and Technical Services departments. + Collaborates with or functions as the Home Therapies Program Manager to oversee the facility's Home Therapies ... Classification of Disease (ICD) coding. + Manages clinic financials including efficient utilization of supplies or equipment and regular profits and loss review. +… more
- Molina Healthcare (Bowling Green, KY)
- …of health care services provided to plan members. * Supports plan utilization management program and accompanying action plan(s), which includes strategies ... the most appropriate care at the most effective setting. *Evaluates effectiveness of utilization management (UM) practices - actively monitoring for over and… more
- Molina Healthcare (Bowling Green, KY)
- …services professionals in some or all of the following functions: care management , utilization management , behavioral health, care transitions, long-term ... For this position we are seeking a (RN) Registered Nurse and/or a Licensed Social Worker who lives in...* Assists in implementing health management , care management , utilization management , behavioral health… more
- Molina Healthcare (Covington, KY)
- …with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications * At ... For this position we are seeking a (RN) Registered Nurse who must hold a compact license. This is...hold a compact license. This is a Remote position, home office with internet connectivity of high speed required… more
- Fresenius Medical Center (Louisville, KY)
- …dialysis clinic. You will collaborate with the Medical Director and the Charge Nurse regarding the provision of quality patient care in the dialysis clinic. ... Human Resources, Quality, and Technical Services departments. + Collaborates with the Home Therapies Manager to oversee the facility's Home Therapies Program.… more
- Molina Healthcare (Owensboro, KY)
- …with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications * At ... (either one or both)) This is a Remote position, home office with internet connectivity of high speed required....equivalent combination of relevant education and experience. * Registered Nurse (RN). License must be active and unrestricted in… more