- CVS Health (Frankfort, KY)
- …And we do it all with heart, each and every day. **Position Summary:** The ** Utilization Management Clinical Nurse Consultant - Prior Authorization** ... internal and external constituents in the coordination and administration of the utilization /benefit management function. + Gathers clinical information and… more
- CVS Health (Frankfort, KY)
- …internal and external constituents in the coordination and administration of the utilization /benefit management function. + Gathers clinical information and ... skills to coordinate, document, and communicate all aspects of the utilization /benefit management program. + Applies critical thinking and knowledge in… more
- Fresenius Medical Center (Georgetown, KY)
- …requirements. Ensure provision of quality patient care while maintaining cost-effective clinical operations in accordance with all legal, compliance, and regulatory ... and FMS patient care and administrative policies as the clinical leader, has the authority to make daily decisions...the liaison for patient care as per the disease management agreement, including initial and ongoing validation of member… more
- Molina Healthcare (Lexington, KY)
- …recommendations for denial or modification of payment decisions. * Serves as a clinical resource for utilization management , chief medical officers, ... the payment Integrity analytical team; makes decisions and recommendations pertinent to clinical experience. * Facilitates document management , clinical … more
- CVS Health (Frankfort, KY)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... self-insured clients. + Application and/or interpretation of applicable criteria and clinical guidelines, standardized care management plans, polices, procedures… more
- Molina Healthcare (Lexington, KY)
- …reports submitted to the Eastern US Quality Improvement Collaborative (EQIC) and/or utilization management committees. + Participates as needed in joint ... **JOB DESCRIPTION** **Job Summary** The Delegation Oversight Nurse provides support for delegation oversight quality improvement activities. Responsible for… more
- Molina Healthcare (Lexington, KY)
- …primary care and medical care services to members - primarily in non- clinical settings where members feel most comfortable, including in-home, community and nursing ... post-discharge coordination to reduce hospital readmission rates and emergency room utilization . * Performs face-to-face in-person visits in a variety of settings… more
- Molina Healthcare (Lexington, KY)
- …recommendations for denial or modification of payment decisions. + Serves as a clinical resource for Utilization Management , Chief Medical Officers, ... of Nursing **REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:** + Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or… more
- Molina Healthcare (Lexington, KY)
- …at least 3 or more years in one or more of the following areas: utilization management , care management , care transitions, behavioral health, or equivalent ... work of external vendors. + Focuses on process improvement, organizational change management , program management and other processes relative to business needs.… more
- Molina Healthcare (Lexington, KY)
- …must be active and unrestricted in state of practice. * Deep understanding of clinical operations: utilization management , care management , etc. * ... education and experience. * At least 3 years health care management /leadership experience. * Registered Nurse (RN) or other advanced clinical or medical… more
- Molina Healthcare (Lexington, KY)
- … and effective resource management . + Develops and implements a Utilization Management program and action plan, which includes strategies that ensure ... analysts to produce tools to report, monitor and improve Utilization Management . + Actively participates in regulatory,...Director in a clinical practice. + Current clinical knowledge. + Experience demonstrating strong management … more
- Molina Healthcare (Lexington, KY)
- … and effective resource management . + Develops and implements a Utilization Management program and action plan, which includes strategies that ensure ... analysts to produce tools to report, monitor and improve Utilization Management . + Actively participates in regulatory,...Director in a clinical practice. + Current clinical knowledge. + Experience demonstrating strong management … more
- Molina Healthcare (Lexington, KY)
- …Preferred License, Certification, Association Active, unrestricted Utilization Management Certification (CPHM). LVN (Licensed Vocational Nurse ) or ... JOB DESCRIPTION Job Summary Provides support for clinical member services review assessment processes. Responsible for...to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required… more
- CVS Health (Frankfort, KY)
- …all with heart, each and every day. Job Description: The Care Management Associate supports comprehensive coordination of medical services including Care Team ... supporting the implementation of care plans to promote effective utilization of healthcare services. Promotes/supports quality effectiveness of Healthcare Services.… more
- Molina Healthcare (Lexington, KY)
- …with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications * At ... JOB DESCRIPTION Job Summary Provides support for clinical member services review assessment processes. Responsible for...in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management … more
- Molina Healthcare (Lexington, KY)
- …Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual ... / MCG guidelines. **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). **MULTI STATE / COMPACT… more
- Veterans Affairs, Veterans Health Administration (Lexington, KY)
- … nurse practitioners, physician assistants, psychologists, psychiatrists, social workers, clinical pharmacists, and nursing staff) to accomplish team goal setting ... specialty care. Coordinates with the patient care team to review the clinic utilization by using various reports (eg, Clinic Utilization Statistical Summary).… more
- Molina Healthcare (Lexington, KY)
- …with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications * At ... JOB DESCRIPTION Job SummaryProvides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary… more