- 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
- Centene Corporation (Frankfort, KY)
- …be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, ... member's overall health, reviewing the type of care being delivered, evaluating medical necessity, and contributing to discharge planning according to care policies… more
- Molina Healthcare (Louisville, KY)
- **Job Description** **Job Summary** The Medical Review Nurse provides support for medical claim and internal appeals review activities - ensuring ... Michigan RN license is required. **Job Duties** + Facilitates clinical / medical reviews of retrospective medical ...nursing experience, including at least 1 year of utilization review , medical claims review , long-term… 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
- Molina Healthcare (Louisville, KY)
- **JOB DESCRIPTION** **Job Summary** The Clinical Appeals Nurse (RN) provides support for internal appeals clinical processes - ensuring that appeals requests ... Central time Remote position **Essential Job Duties** * Performs clinical / medical reviews of previously denied cases in...specific programs supported by the plan such as utilization review , medical claims review , long-term… more
- Elevance Health (Louisville, KY)
- …states; therefore, Multi-State Licensure will be required.** The ** Medical Management Nurse ** is responsible for review of the most complex or challenging ... ** Medical Management Nurse ** **Location: Virtual: This...management experience and requires a minimum of 2 years clinical , utilization review , or managed care experience;… more
- ChenMed (Louisville, KY)
- …join our team. The Nurse Practitioner (NP) acts as part of the clinical operations team and is responsible for providing direct patient care in ChenMed/Jencare ... and summaries. The Nurse Practitioner (NP) acts as part of the clinical operations team and is responsible for providing direct patient care in ChenMed/Jencare … more
- Veterans Affairs, Veterans Health Administration (Louisville, KY)
- …positions are filled. Responsibilities VA Careers - Licensed Practical Nurse : https://youtube.com/embed/Ae85IP1Oiz4 Total Rewards of a Allied Health Professional ... This Licensed Practical Nurse (LPN) position is located within Primary Care at...a VHA Patient Aligned Care Team (PACT), a patient-centered medical home model of care that is accessible, timely,… 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
- Datavant (Frankfort, KY)
- …years of CDI experience + 3+ years of clinical experience in an academic medical center + Registered Nurse license, Bachelor's degree in Nursing + CCDS or ... realize our bold vision for healthcare. **What We're Looking For:** As a Clinical Documentation Quality Improvement (CDQI) Specialist, you will play a pivotal role… more
- Elevance Health (Louisville, KY)
- **Telephonic Nurse Case Manager II** **Location:** This role enables associates to work virtually full-time, with the exception of required in-person training ... hours of receipt and meet the criteria._** The **Telephonic Nurse Case Manager II** is responsible for care management...management plan and modifies as necessary. + Interfaces with Medical Directors and Physician Advisors on the development of… more
- Elevance Health (Louisville, KY)
- …Group Clinical Validation Auditor** is responsible for auditing inpatient medical records to ensure clinical documentation supports the conditions and ... DRGs billed and reimbursed. Specializes in review of Diagnosis Related Group (DRG) paid claims. **How...an impact:** + Analyzes and audits claims by integrating medical chart coding principles, clinical guidelines, and… 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
- 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
- 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
- Elevance Health (Louisville, KY)
- ** Nurse Case Manager II** **Location** : This role enables associates to work virtually full-time, with the exception of required in-person training sessions, ... 48 hours of receipt and meet the criteria._** The ** Nurse Case Manager II** is responsible for care management...management plan and modifies as necessary. + Interfaces with Medical Directors and Physician Advisors on the development of… more
- Oracle (Frankfort, KY)
- …+ Excellent communication, stakeholder engagement, and leadership skills. **Preferred Qualifications:** + Clinical experience as a nurse or physician with a deep ... **Job Description** The Clinical Note AI Agent Product Management Leader will...Gather and analyze information to define product specifications and review design specifications. Envision and communicate product strategy and… more
- Highmark Health (Frankfort, KY)
- …over a specified panel of members that range in health status/severity and clinical needs; and assesses health management needs of the assigned member panel and ... utilizing data/analytics in conjunction with professional clinical judgement to identify the right clinical intervention for each member. The incumbent conducts… more