- CenterWell (Frankfort, KY)
- …healthcare industry. The UM Administration Coordinator - Phone Intake contributes to administration of utilization management . The UM Administration ... works on semi-routine assignments. Shift Hours - 8a - 5 The UM Administration Coordinator - Phone Intake provides non-clinical support for the policies and… more
- Molina Healthcare (Lexington, KY)
- …HMO regulations, managed healthcare systems, quality improvement, medical utilization management , risk management , risk adjustment, disease management ... Summary** Responsible for serving as the primary liaison between administration and medical staff. Assures the ongoing development and...resource management . + Develops and implements a Utilization Management program and action plan, which… more
- Molina Healthcare (Lexington, KY)
- …HMO regulations, managed healthcare systems, quality improvement, medical utilization management , risk management , risk adjustment, disease management ... and effective resource management . + Develops and implements a Utilization Management program and action plan, which includes strategies that ensure… more
- Humana (Frankfort, KY)
- …the coordination, documentation, and communication of medical services and/or benefit administration determinations. The Senior Utilization Management ... of our caring community and help us put health first** The Senior Utilization Management Behavioral Health Professional utilizes behavioral health knowledge and… more
- CVS Health (Frankfort, KY)
- …Stay) to clinical staff. + Identifies triggers for referral into Aetna's Case Management , Disease Management , Mixed Services, and other Specialty Programs. ... assist in the research and resolution of claims payment issues. + Supports the administration of the hospital care, case management and quality management … more
- Evolent (Frankfort, KY)
- …Doing:** As a Cardiology, Field Medical Director you will be a key member of the utilization management team. We can offer you a meaningful way to make a ... the Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. +… more
- Molina Healthcare (Lexington, KY)
- …clinical systems analysis, or equivalent experience * 2 or more years in case, disease , or utilization management ; managed care; or medical/behavioral health ... development, implementation, and collaboration with the delivery of training curriculum for Utilization Management , Case Management , and LTSS staff. **Job… more
- CVS Health (Frankfort, KY)
- …Aetna/CVS Health. Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible ... interpretation of applicable criteria and clinical guidelines, standardized care management plans, polices, procedures and regulatory standards while assessing… more
- CVS Health (Frankfort, KY)
- …Aetna/CVS Health. Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible ... interpretation of applicable criteria and clinical guidelines, standardized care management plans, polices, procedures and regulatory standards while assessing… 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 ... participates as the physician member of the multidisciplinary team for case and disease management . They will advise the multidisciplinary team on cases,… more
- Fujifilm (Frankfort, KY)
- …Biomarkers sales through that community. As assigned interface with Senior Management teams from major IVD manufacturers. Maintain a comprehensive understanding of ... **Job Description** **Duties and responsibilities** + Must be able to demonstrate disease state competency and articulate a strong value proposition for the… more