- Elevance Health (Louisville, KY)
- **Clinical Operations Medical Director** ** Utilization Management of Medical Oncology Benefits** **Carelon Benefits Management ** **$20,000 Sign On Bonus** ... members and providers. **Job Summary:** + Perform physician-level case review , following initial nurse review ,...maintain knowledge of relevant policies and regulations pertaining to utilization review of oncology care. + Participate… more
- Humana (Frankfort, KY)
- … management personnel and oversee all utilization management functions, including inpatient admissions, concurrent review , prior authorization, and ... put health first** Humana Healthy Horizons in Virginia is seeking a Manager, Utilization Management (Behavioral Health) who will utilize their clinical skills to… more
- Humana (Frankfort, KY)
- …of our caring community and help us put health first** The Manager, Utilization Management Nursing uses clinical knowledge, communication skills, and independent ... the daily management and operations of the department. Oversees utilization management functions which include timely authorizations related to… more
- Humana (Frankfort, KY)
- …part of our caring community and help us put health first** The Utilization Management Behavioral Health Professional 2 utilizes behavioral health knowledge and ... and communication of medical services and/or benefit administration determinations. The Utilization Management Behavioral Health Professional 2 work assignments… more
- Elevance Health (Louisville, KY)
- ** Utilization Management Representative II** **Location** : This position will work remotely. The ideal candidate will live within 50 miles of one of the ... Atlanta, GA; Chicago, IL; Indianapolis, IN; Louisville, KY; The ** Utilization Management Representative II** is responsible for...the provider on referrals given. Refers cases requiring clinical review to a nurse reviewer; and handles… more
- ChenMed (Louisville, KY)
- …of 2 years' clinical work experience required. + A minimum of 1 year of utilization review and/or case management , home health, hospital discharge planning ... people to join our team. * The Acute Care Nurse is responsible for achieving positive patient outcomes, managing...patients' progress and adjust and plan accordingly. + Understanding utilization review and how to leverage with… more
- Elevance Health (Louisville, KY)
- ** Nurse Medical Management II** At **Federal...3 years of acute care clinical experience or case management , utilization management or managed ... 7 pm (EST) shift rotation twice a month.** The ** Nurse Medical Management II** is responsible for...Will Make an Impact** + Conducts precertification, continued stay review , care coordination, or discharge planning for appropriateness of… more
- ChenMed (Louisville, KY)
- …explain nurse practitioner role. + Facilitates patient/family conferences to review treatment goals, optimize resource utilization , provide family education ... we need great people to join our team. The Nurse Practitioner (NP) acts as part of the clinical...management programs, clinical meetings and other meetings. The Nurse Practitioner will adhere to strict departmental goals/objectives, standards… more
- Fresenius Medical Center (Louisa, KY)
- …auditing activities. + Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. + Manages clinic ... financials including efficient utilization of supplies or equipment and regular profits and...of supplies or equipment and regular profits and loss review . + Responsible for all required network reporting and… more
- Marriott (Frankfort, KY)
- …with Claims department regarding case management . + Collaborate with UNM on utilization review issues. + Refer catastrophic cases in coordination with claims ... claims most likely to benefit from case management to meet jurisdictional needs. ** Utilization Review ** + Provide initial clinical review in order to… more
- BrightSpring Health Services (Louisville, KY)
- …state of hire as a nurse + Two years of experience in health care utilization review or home care + Expert written and verbal communication skills and the ... Our Company BrightSpring Health Services Overview Clinical Denials Management and Audit monitors, responds to, and performs...per applicable home health regulations for submission for pre-claim review process of Review Choice Demonstration +… more
- AdventHealth (Manchester, KY)
- …patient populations, promotes the achievement of optimal clinical and resource utilization allocation, coordinates across the health care continuum for all patients ... patients and families. Responsible for coordinating a wide range of self- management support and disease registry activities for the office's patient population.… 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 ... DC, Puerto Rico and the United Kingdom. Benefits for Utilization Review Coordinator include: + Challenging and...Degree in Social Work or Psychology + Experience in Utilization Management preferred + Current CPR or… more
- Fresenius Medical Center (Louisville, KY)
- …and programs. Collaborates with the Medical Director and the Clinical Coordinator /Charge Nurse or Nurse Supervisor regarding the provision of quality patient ... closely with, providing oversight as needed to, the Clinical Coordinator/Charge RN or Nurse Supervisor acting as nurse manager, the Medical Director, and the… more
- CenterWell (Danville, KY)
- …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and ... requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking...and reliable transportation. + Two years as a Registered Nurse with at least one-year of management … more
- STG International (Hopkinsville, KY)
- …in quality improvement, care management , risk management , peer review , utilization review , clinical outcomes, and health enhancement activates. ... Participate in the orientation of clinical staff physicians, physician assistants and nurse practitioners. + Provide leadership to CBOC clinicians. + Evaluate the… more
- BrightSpring Health Services (Louisville, KY)
- …nursing from an accredited or approved school + Two years of experience in health care utilization review or home health care + Clinical review will require ... up as needed with appropriate staff and/or department for correction + Review coding to ensure documentation is completed within Agency's admission timeframe +… more
- Universal Health Services (Lexington, KY)
- …information and forwarding to appropriate agencies, in conjunction with Business Office and Utilization Review . What We Offer You: + Challenging and rewarding ... Hospitalization, Intensive Outpatient Programs, Individual Counseling, as well as Medication Management for all ages. We have provided behavioral health services to… more
- LifePoint Health (Versailles, KY)
- …and fosters an environment that encourages professional growth. Initiates weekend case management , Utilization review screening, assists with D/C planning ... Care (Physical Training) - within 60 days of hire and renewed annuallyTrauma Nurse Core Course (TNCC) - PreferredENPC - preferredNRP - preferredNIHSS - required… more
- Teleflex (Lexington, KY)
- …territory. The incumbent is responsible for the growth of overall product utilization within their accounts including, but not limited to, selling the designated ... time in the field. * Facilitate sales growth by conducting physician, nurse , and technologist training and account in-servicing of dialysis access products. *… more