- Evolent (Frankfort, KY)
- …scheduled. + Determines medical necessity and appropriateness of services using clinical review criteria. + Accurately documents all review ... for the mission. Stay for the culture. **What You'll Be Doing:** The Nurse Reviewer is responsible for performing precertification and prior approvals. Tasks… more
- Molina Healthcare (Louisville, KY)
- …for a RN with experience with appeals, claims review , and medical coding. **Job Summary** Utilizing clinical knowledge and experience, responsible for ... Payment Integrity analytical team; requires decision making pertinent to clinical experience + Documents clinical review...clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review .… more
- Fresenius Medical Center (Louisville, KY)
- …or federal surveys. + Participates in the completion of the FMS Administrative Clinical Review . **PHYSICAL DEMANDS AND WORKING CONDITIONS:** + The physical ... requirements. Ensure provision of quality patient care while maintaining cost-effective clinical operations in accordance with all legal, compliance, and regulatory… more
- Elevance Health (Louisville, KY)
- ** Nurse Audit Senior - Payment Integrity Complex and Clinical Audit** **Location:** This role enables associates to work virtually full-time, with the exception ... formerly Payment Integrity, is determined to recover, eliminate and prevent unnecessary medical -expense spending. The ** Nurse Audit Senior** will be responsible… more
- ChenMed (Louisville, KY)
- …JOB FUNCTIONS: The Nurse Practitioner (NP) acts as part of the clinical operations team and is responsible for providing direct patient care in ChenMed/Jencare ... This position may require to participate in risk and quality management programs, clinical meetings and other meetings. The Nurse Practitioner will adhere to… more
- ChenMed (Louisville, KY)
- …This position may require participation in risk and quality management programs, clinical meetings and other meetings. The Nurse Practitioner will adhere ... nurse practitioner role. + Facilitates patient/family conferences to review treatment goals, optimize resource utilization, provide family education and identify… more
- Gentiva (New Albany, IN)
- …(LCD) criteria per hospice policy and regulatory requirements. + Communicate clinical findings, review treatment plans, lab results, diagnostics, and ... Partnerships. Transform Hospice Care.** We are seeking a dedicated Hospice Nurse Practitioner to perform Face-to-Face (F2F) encounters essential for hospice… more
- Surgery Care Affiliates (New Albany, IN)
- …do it. Each decision we make is rooted in seven core values: + Clinical quality + Integrity + Service excellence + Teamwork + Accountability + Continuous improvement ... package to support your health, well-being, and financial future. Our offerings include medical , dental, and vision coverage, 401k plan with company match, paid time… more
- BrightSpring Health Services (Louisville, KY)
- …authorizations, and document all interactions with patients regarding medication adjustments. . Review and process clinical orders as needed, ensuring compliance ... Our Company Abode Care Partners Overview The Nurse Care Manger is an LPN who plays...crucial role in delivering patient-centered care by focusing on clinical assessments, care planning, and patient education. Working closely… more
- HCA Healthcare (Frankfort, KY)
- …is important to you, we encourage you to apply for our Labor and Delivery Nurse PRN opening. Our team will promptly review your application. Highly qualified ... to deliver excellent care patients deserve? At Frankfort Regional Medical Center we support our colleagues in their positions....positions. Join our Team as a(an) Labor and Delivery Nurse PRN and access programs to assist with every… more
- CVS Health (Frankfort, KY)
- …benefit overall claim management. + Using a holistic approach, consults with clinical colleagues, supervisors, Medical Directors and/or other programs to ... in the US with virtual training.** American Health Holding, Inc (AHH) is a medical management company that is a division within Aetna/CVS Health. Founded in 1993,… more
- HCA Healthcare (Frankfort, KY)
- …is important to you, we encourage you to apply for our Progressive Care Nurse opening. Our team will promptly review your application. Highly qualified ... to deliver excellent care patients deserve? At Frankfort Regional Medical Center we support our colleagues in their positions....their positions. Join our Team as a(an) Progressive Care Nurse and access programs to assist with every stage… more
- HCA Healthcare (Frankfort, KY)
- …$25,000 Sign-On Bonus Do you have the career opportunities as a(an) Step Down Nurse you want with your current employer? We have an exciting opportunity for you ... to join Frankfort Regional Medical Center which is part of the nation's leading...Do you want to work as a(an) Step Down Nurse where your passion for creating positive patient interactions… more
- Wellpath (La Grange, KY)
- …personnel are qualified to perform the services they provide. **Key Responsibilities** + Review and ensure compliance of nursing plans, medical records, and ... **Perks and Benefits** In addition to comprehensive benefits including medical , dental, vision, paid time off, and 401k, we...a very large percent of those individuals receive direct clinical care, which includes lives saved by Narcan. We… more
- Veterans Affairs, Veterans Health Administration (Louisville, KY)
- …a primary care provider (MD, NP, PA), registered nurse care manager, clinical associate (LPN or medical assistant/ health technician) and an administrative ... range of medical clinicians across multiple disciplines (eg medical doctors, nurse practitioners, physician assistants, psychologists, psychiatrists, social… more
- Cardinal Health (Frankfort, KY)
- …to ensure a positive and satisfactory experience for all customers. The Supervisor, Clinical Operations monitors nurse to patient contact quality and provides ... manufacturers to rethink the reach and impact of their products. The Supervisor, Clinical Operations provides management and clinical oversight to a team of… more
- Fujifilm (Frankfort, KY)
- **Position Overview** The Clinical Consultant, MI - I shall be responsible for providing clinical consulting for the project, report configuration (CV), workflow ... go-live support to Synapse PACS/MI projects. In addition, provide clinical support for sales and company team members with...HCUS team to gain customer acceptance of the FUJIFILM Medical Systems solution. + Participates in teaching and training… more
- Molina Healthcare (Louisville, KY)
- …records and other data in support of annual HEDIS project management and ongoing review of medical records submitted by providers. + Implements Molina Healthcare ... completion of any of the following programs: + Registered Nurse (RN) or State Licensed Vocational Nurse ... records collection and abstraction * 2+ years of medical record review experience **REQU** **I** **RED… more
- Molina Healthcare (Louisville, KY)
- JOB DESCRIPTION Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically ... necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members...requests within required timelines. * Refers appropriate cases to medical directors (MDs) and presents cases in a consistent… more
- Molina Healthcare (Louisville, KY)
- …, and medical coding. JOB DESCRIPTION Job SummaryProvides support for clinical member services review assessment processes. Responsible for verifying that ... For this position we are seeking a (RN) Registered Nurse who must hold a compact license. This is...services are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members… more