- Humana (Frankfort, KY)
- …part of our caring community and help us put health first** The SNF Utilization Management Nurse uses clinical knowledge, communication skills, and ... where needed. Follows established guidelines and procedures. The SNF Utilization Management Nurse uses clinical...an impact** **Required Qualifications** + Compact licensure + Licensed Registered Nurse ( RN ) in the… more
- Signature Healthcare (Louisville, KY)
- …Care documentation to facility accurate billing. What you Need to make a Difference + Registered Nurse ( RN ) in good standing with required current state ... communication with leadership, patients, families, internal care givers, and external Utilization Management Nurses. + Coordinate internal and external health… more
- Fresenius Medical Center (Louisville, KY)
- …Classification of Disease (ICD) coding. + Manages clinic financials including efficient utilization of supplies or equipment and regular profits and loss review. + ... of education and experience. + Graduate of an accredited School of Nursing ( RN ). + Current appropriate state licensure. **EXPERIENCE AND SKILLS:** + Required: + 6+… more
- Sharecare (Frankfort, KY)
- …cost effective, appropriate resource utilization and quality outcomes. The Clinical Registered Nurse is also responsible for early identification of those ... according to the disease management program intervention guidelines. A Clinical Registered Nurse is supervised by an Operations Manager (OM). All Sharecare… more
- Veterans Affairs, Veterans Health Administration (Louisville, KY)
- … Nurse - Nuclear Cardiology. Responsibilities Specialty Care Outpatient Staff Registered Nurse ( RN ) is responsible for providing competent, ... and coaching on wellness, disease prevention, and chronic care management . The nurse will assist in directing...level degree in Nursing may have opportunity to become registered as a nurse with a state… more
- CVS Health (Frankfort, KY)
- …care. + Perform medical necessity reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse ( RN ) with at least 1 year of experience ... is URAC accredited in Case Management , Disease Management and Utilization Management . AHH...in a hospital setting. + A Registered Nurse that holds an active, unrestricted… more
- ChenMed (Louisville, KY)
- …We're rapidly expanding and we need great people to join our team. The Registered Nurse , Care Line, is responsible for providing telephonic triage directional ... Triage assessments within license and as possible given technology and medium. The registered nurse collaborates with primary caregivers and others on the… more
- Humana (Frankfort, KY)
- …and programs **Use your skills to make an impact** **Required Qualifications** + Registered nurse ( RN ) with unrestricted licensed **OR** independent licensed ... of our caring community and help us put health first** The Utilization Management (UM) Director, Clinical Strategy and Practice for Medicaid builds strategies… more
- CVS Health (Frankfort, KY)
- …Health Clinician ( LPCC, LCSW, LMFT, LPAT ) - OR - Active unrestricted Compact Registered Nurse ( RN ) license with psychiatric specialty or behavioral health ... every day. **Position Summary** This is a fulltime remote Utilization Management Clinical Consultant opportunity with Aetna...(LPCC, LCSW, LMFT, LPAT) OR Minimum of a Diploma RN or Associate's degree in Nursing **Anticipated Weekly Hours**… more
- Humana (Frankfort, KY)
- …Family Therapist **(LMFT)** , Licensed Professional Counselor **(LPC)** , Psychologist **(PhD)** , Registered Nurse **( RN )** or other professional license. + ... health first** Humana Healthy Horizons in Kentucky is seeking a Utilization Management Behavioral Health Professional 2 who utilizes behavioral health knowledge… more
- Molina Healthcare (Louisville, KY)
- …Chief Medical Officer on denial decisions. + Resolves escalated complaints regarding Utilization Management and Long-Term Services & Supports issues. + ... as may be required. + Serves as a clinical resource for Utilization Management , Chief Medical Officer, Physicians, and Member/Provider Inquiries/Appeals. +… more
- Highmark Health (Frankfort, KY)
- …Nursing **EXPERIENCE** **Required** + 7 years in any combination of clinical, case/ utilization management and/or disease/condition management experience, or ... required depending on where clinical care is being provided. **Preferred** + Certification in utilization management or a related field + Certification in Case … more
- CenterWell (Elizabethtown, KY)
- …license, auto insurance and reliable transportation. + Two years as a Registered Nurse with at least one-year of management experience in a home care, ... clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates...School of Nursing. + Current state license as a Registered Nurse . + Proof of current CPR.… more
- Molina Healthcare (Louisville, KY)
- …for internal meetings. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse ( RN ). **Required Experience** 1-3 years of ... **JOB DESCRIPTION** Opportunity for experienced Utilization Review RN in United States...transplants; the ideal candidate will have experience either in utilization review or case management for transplants.… more
- HCA Healthcare (Frankfort, KY)
- …Nursing required; Master's Degree in healthcare-related field preferred. + Current licensure as a Registered Nurse ( RN ) in the state of Kentucky or compact ... effective labor management , including position control, scheduling excellence, productivity management , and premium pay utilization to maintain staffing to… more
- Elevance Health (Louisville, KY)
- **Medical Management Nurse ** **Location:** This role enables associates to work virtually full-time, with the exception of required in-person training sessions, ... will drive the future of health care. The **Medical Management Nurse ** is responsible for reviewing the...experience and requires a minimum of 2 years clinical, utilization review, or managed care experience; or any combination… more
- Elevance Health (Louisville, KY)
- …pm EST. The **Telephonic Nurse Case Manager II** is responsible for care management within the scope of licensure for members with complex and chronic care needs ... **Telephonic Nurse Case Manager II** **Location:** This role enables...claims or service issues. + Assists with development of utilization /care management policies and procedures. **Minimum** **Requirements:**… 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 ...and Preferred:** + 1-3 years' experience and as an RN - **Required** + Minimum of 5 years in… more
- United Therapeutics (Frankfort, KY)
- …years of PAH nursing experience, including ICU and critical care of PAH patients + Registered Nurse ( RN ) - State Licensure and/or Compact State Licensure ... make a difference. The Regional Field Director, RNS Program Management serves as a director of all clinical field...RN - Registered Nurse - State Licensure and/or Compact… more
- Humana (Frankfort, KY)
- …DSNP program **Use your skills to make an impact** **REQUIRED QUALIFICATIONS:** + Registered nurse ( RN ) with unrestricted licensed **OR** independent ... **Key Functions:** **Strategic Planning and Implementation:** + Develop and implement utilization management strategies that align with organizational goals. +… more