- 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 ... and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are varied… 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 ... and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are varied… more
- CenterWell (Frankfort, KY)
- …caring community and help us put health first** The Compliance Nurse 2 reviews utilization management activities and documentation to ensure adherence ... prevent and detect fraud, waste, and abuse. The Compliance Nurse 2 work assignments are varied and...experience a plus + Previous experience in chronic disease management , utilization management , case … more
- CVS Health (Frankfort, KY)
- …Must have active current and unrestricted RN licensure in state of residence. + Utilization Management is a 24/7 operation and work schedules will include ... in med surg or specialty area. + Managed Care experience preferred, especially Utilization Management . + Preference for those residing in Eastern Standard Time… more
- Molina Healthcare (Owensboro, KY)
- …state they reside. We are looking for a RN Manager to manage a utilization management team supporting 14 Marketplace plans. Home office with internet ... cover any weekend time if needed Preferred candidate with Utilization Management and leadership experience (Direct Reports)..., case management , care transition and/or disease management . + Minimum 2 years of healthcare… more
- Humana (Frankfort, KY)
- …help us put health first** Humana Healthy Horizons in Kentucky is seeking a Utilization Management Behavioral Health Professional 2 who utilizes behavioral ... and communication of medical services and/or benefit administration determinations. The Utilization Management Behavioral Health Professional 2 work… more
- Humana (Frankfort, KY)
- …of our caring community and help us put health first** The Senior Compliance Nurse reviews utilization management activities and documentation to ensure ... and detect fraud, waste, and abuse. The Senior Compliance Nurse work assignments involve moderately complex to complex issues...Minimum two, ( 2 ) years of experience in utilization management + Intermediate proficiency using Microsoft… more
- HCA Healthcare (Bowling Green, KY)
- …effective labor management , including position control, scheduling excellence, productivity management , and premium pay utilization to maintain staffing to ... 156,000 hours impacting our communities. As a Medical Surgical Nurse Director with TriStar Greenview Regional Hospital, you can...the state of Kentucky or compact state required. + 2 years of Medical/Surgical experience required. + Management… more
- Wellpath (Sandy Hook, KY)
- …by superiors. **Qualifications & Requirements** Education + Graduation from an accredited nurse practitioner program. Experience + Two ( 2 ) years of experience ... of care support. **How you make a difference** The Psychiatric Nurse Practitioner(Psych NP)follows established policies and procedures and state guidelines, ensuring… more
- Intermountain Health (Frankfort, KY)
- …cost-effective outcomes. Provides focused support to various areas such as utilization management , emergency department, acute, ambulatory and specialty care. ... in examining patterns of health care needs, decisions, lifestyle choices, and utilization of resources that affect their health. + Advocates, educates and coaches… more
- CVS Health (Frankfort, KY)
- …unrestricted state licensure required in state of residence **Preferred Qualifications** Utilization Management review Managed Care experience Client processing ... resources and conduct reviews. **Required Qualifications** 5+ years of clinical experience required 2 + years of experience as a Registered Nurse with current… 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 ...business need of nurses providing coverage until 7:00pm CST. 2 days/week 8am - 5pm EST/CST - **Required** +… more
- Molina Healthcare (KY)
- … and effective resource management . + Develops and implements a Utilization Management program and action plan, which includes strategies that ensure ... IT and data analysts to produce tools to report, monitor and improve Utilization Management . + Actively participates in regulatory, professional and community… more
- Molina Healthcare (Lexington, KY)
- … and effective resource management . + Develops and implements a Utilization Management program and action plan, which includes strategies that ensure ... IT and data analysts to produce tools to report, monitor and improve Utilization Management . + Actively participates in regulatory, professional and community… more
- HCA Healthcare (Bowling Green, KY)
- …Worker (LMSW), required + 3+ years' experience in overall acute care Hospital Case Management , preferred + 2 + years' experience in case management ... organization that invests in you as a(an) Director Case Management ? At TriStar Greenview Regional Hospital, you come first....to ensure continuity of care and optimal clinical resource utilization . The Director has oversight for all aspects of… more
- Select Medical (Danville, KY)
- … within the plan of care. + Demonstrates compliance with facility-wide Utilization Management policies and procedures. + Coordinates UR compliance with ... current licensure in a clinical discipline either as a Nurse or a Respiratory Therapist OR Social Work SW/MSW...what is right. The Case Manager is responsible for utilization reviews and resource management , discharge planning,… more
- Veterans Affairs, Veterans Health Administration (Louisville, KY)
- …early discharge through collaboration with specialists, nursing staff, social services, utilization management , and other members of the interdisciplinary team. ... patients referred to the hospitalist services and close coordination with the nurse director and hospital departments to ensure high quality, effective patient care… more
- Molina Healthcare (Owensboro, KY)
- …including 3 or more years in one or more of the following areas: utilization management , case management , care transition and/or disease management ... For this position we are seeking a (RN) Registered Nurse who must be licensed for the state they...external vendors. + Focuses on process improvement, organizational change management , program management and other processes relative… more
- CVS Health (Bowling Green, KY)
- …do it all with heart, each and every day. **Position Summary** The Complex Nurse Case Manager is responsible for assessing members through regular and consistent in ... person or telephonic contact to assess, plan, implement and coordinate all case management activities with members to evaluate the medical and psychosocial needs of… more