- Molina Healthcare (Lexington, KY)
- …while contributing to enterprise-wide strategies for integrated behavioral health programs, utilization management standardization, and cost-effective ... psychiatric leadership and clinical expertise for utilization management , case management , and integrated behavioral health /chemical dependency… more
- Molina Healthcare (Lexington, KY)
- …or all of the following functions: utilization management , care management , care transitions, behavioral health , long-term services and supports ... care services (HCS) functions: care management , care transitions, utilization management , behavioral health and/or nurse advice line. Demonstrates… more
- CVS Health (Frankfort, KY)
- …clinically appropriate treatment, evidence-based care and clinical practice guidelines for Behavioral Health and/or medical conditions based upon program focus. ... + Must reside in Kentucky or bordering Counties + Licensed independent behavioral health clinician with Kentucky state licensure (LCSW, LPCC, LMFT,… more
- Highmark Health (Frankfort, KY)
- …coverage determination for prior authorization review and appeals. Through the Utilization Review system, the incumbent evaluates clinical information provided by ... prior authorization or appeals against medical policy through the Utilization Review system. Update the system records appropriately to...job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of… more
- CenterWell (Frankfort, KY)
- …+ Prior clinical experience, managed care experience, DME, Florida Medicaid **OR** utilization management experience + Demonstrates Emotional Maturity + Ability ... procedures + Compact License preferred + Previous experience in utilization management within Insurance industry + Previous...and for the lowest cost. We go beyond physical health - addressing the social, emotional, behavioral … 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
- Highmark Health (Frankfort, KY)
- …This role supports the full application product lifecycle for **clinical and utilization management software** , with a specific focus on driving ... function as a pivotal bridge, translating high-level **clinical and utilization management software** business needs into detailed...job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of… more
- Highmark Health (Frankfort, KY)
- …and financial stakeholders **Preferred** + Experience with medical policy and utilization management functions + Medical coding experience **LICENSES or ... decisions, ensuring alignment with the Quadruple Aim of Healthcare: lower per capita health care costs, improved outcomes and quality of care received, and optimal… more
- CVS Health (Frankfort, KY)
- …advanced clinical judgment and critical thinking, the RN coordinates physical and behavioral health services, collaborates with providers, and ensures access to ... psychosocial support services. The goal is to optimize resource utilization and drive positive health outcomes. The...management . + Identify and address social determinants of health impacting care. + Refer members to appropriate care… more
- Highmark Health (Frankfort, KY)
- …impact corporate performance + Researches, manipulates, and prepares data related to Health Management programs that document program activities and the results ... the impact of Highmark's business decisions on Informatics, personnel utilization , and the use and planning of technology. The role...of Health Management… more
- Highmark Health (Frankfort, KY)
- …of various projects and data analysis related to Medical Policy and Utilization Management . **ESSENTIAL RESPONSIBILITIES** + Perform management ... a supervisory capacity or role **Preferred** + Experience in Utilization Management and/or Medical PolicyExperience working with...job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of… more
- Highmark Health (Frankfort, KY)
- …supporting, and optimizing the architectural strategy for **all clinical and utilization management applications** . Their expertise spans application, solution, ... and AI integration, extending this strategic oversight across **all clinical and utilization management applications** . This involves ensuring the completeness… more
- Highmark Health (Frankfort, KY)
- …and education or if necessary involve Special Investigation Unit or the Utilization Management area. **ESSENTIAL RESPONSIBILITIES** + Implement the pre-payment ... data to assure appropriate level of payment and resource utilization . It is also used to identify issues which...measurable outcomes. Will monitor and analyze the delivery of health care services in accordance with claims submitted, and… more
- Highmark Health (Frankfort, KY)
- …and mentorship in areas of expertise and architecture to peers, developers, management , and business users. **Key Responsibilities:** + Lead the design and ... application designs to ensure optimal technology selection, efficient resource utilization , and seamless system integration. + Ensure system architecture adheres… more
- Highmark Health (Frankfort, KY)
- **Company :** Highmark Health **Job Description :** **JOB SUMMARY** This job plays a key role in ensuring projects (ie change initiatives) meet objectives on time ... and minimize risk to implementation. Works to drive faster adoption, higher ultimate utilization and greater proficiency of the changes that impact employees in the… more
- HCA Healthcare (Lexington, 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 ... this role:Supervises, monitors, and ensures competencies and performance of assigned home health care team(s)Supervises ongoing case management of all patients… more
- Highmark Health (Frankfort, KY)
- …Provide analytical/strategic-thinking and leadership support that enables the medical policy and utilization management teams to: 1) isolate business issues; 2) ... to junior team members; Provide performance input and recommendations to management for development/ training plans. May have supervisory responsibilities on a… more
- Highmark Health (Frankfort, KY)
- …contribute to highest levels of performance. **ESSENTIAL RESPONSIBILITIES** + Perform management responsibilities including, but limited to: involved in hiring and ... termination decisions, coaching and development, rewards and recognition, performance management and staff productivity.Plan, organize, staff, direct, and control… more
- Highmark Health (Frankfort, KY)
- …expertise.This may include updating/revising existing medical policies. + Partner with Utilization Management and other operational teams to identify ... job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of...with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as… more
- HCA Healthcare (Frankfort, 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 ... labor management , including position control, scheduling excellence, productivity management , and premium pay utilization . Maintains staffing to ensure… more