- Humana (Louisville, KY)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... benefit administration determinations for Humana's Kentucky Medicaid Plan. The Utilization Management Nurse 2 work...skills to make an impact** **Required Qualifications** + Licensed Registered Nurse (RN) in the state of… more
- CVS Health (Frankfort, KY)
- …both verbal and written. **Required Qualifications** + 2+ years of experience as a Registered Nurse in adult acute care/critical care setting. + Must have active ... current and unrestricted RN licensure in state of residence. + Utilization Management is a 24/7 operation and work schedules will include weekends, holidays, and… more
- Signature Healthcare (Louisville, KY)
- …communication with leadership, patients, families, internal care givers, and external Utilization Management Nurses. + Coordinate internal and external health ... billing. What you Need to make a Difference + Registered Nurse (RN) in good standing with...Previous experience with MDS and assessment preferred Hospital Case Management /Hospital Utilization Management . Obtaining… more
- Veterans Affairs, Veterans Health Administration (Louisville, KY)
- …Louisville KY is current recruiting for a Specialty Care Outpatient Staff Registered Nurse - Nuclear Cardiology. Responsibilities Specialty Care Outpatient Staff ... Registered Nurse (RN) is responsible for providing...and coaching on wellness, disease prevention, and chronic care management . The nurse will assist in directing… more
- Humana (Frankfort, KY)
- …a part of our caring community and help us put health first** The Utilization Management (UM) Director, Clinical Strategy and Practice for Medicaid builds ... of how organization capabilities interrelate across the function or segment. The Utilization Management (UM) Director, Clinical Strategy and Practice for… 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 ... reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse (RN) with at least 1...Specialty Pharmacy** **.** **Preferred Qualifications** + 1+ years' Case Management experience or discharge planning, nurse navigator… more
- CVS Health (Frankfort, KY)
- …SEE REQUIRED QUALIFICATIONS FOR LICENSING DETAILS_** This is a fulltime remote Utilization Management Clinical Consultant opportunity with Aetna Better Health of ... to coordinate, document and communicate all aspects of the utilization /benefit management program. + Applies critical thinking...LMFT, LPAT_** **_) - OR - Active unrestricted Compact Registered Nurse (RN) license with psychiatric specialty… more
- Sharecare (Frankfort, KY)
- …cost effective, appropriate resource utilization and quality outcomes. The Clinical Registered Nurse is also responsible for early identification of those ... learn more, visit www.sharecare.com . **Job Summary:** The Clinical Registered Nurse has the responsibility for supporting...disease management program intervention guidelines. A Clinical Registered Nurse is supervised by an Operations… 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
- 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. + ... + Preferred but not required: + 3+ years supervisory or project/program management experience. + Med/surg or ICU/CCU experience. **PHYSICAL DEMANDS AND WORKING… 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 state ... effective labor management , including position control, scheduling excellence, productivity management , and premium pay utilization to maintain staffing to… more
- Molina Healthcare (Louisville, KY)
- … Nurse in good standing. **Preferred Education** Completion of an accredited Registered Nurse (RN) Program or a bachelor's degree in Nursing. **Preferred ... contained in the delegation agreement. **KNOWLEDGE/SKILLS/ABILITIES** The Delegation Oversight Nurse is responsible for ensuring that Molina Healthcare's UM… 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
- Lincoln Financial (Frankfort, KY)
- …as indicated **What we're looking for** * 4 Year/Bachelor's Degree in Nursing * Registered Nurse License - Current, unrestricted license in the state where the ... We are excited to bring on a highly motivated Nurse Disability Consultant to our clinical organization. This position...Care, , Trauma , Disability, Workman's comp or case management or Utilization review **Application Deadline** **What's… 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 RN - ... make a difference. The Regional Field Director, RNS Program Management serves as a director of all clinical field...Registered Nurse - State Licensure and/or Compact… more
- Humana (Frankfort, KY)
- …**Key Functions:** **Strategic Planning and Implementation:** + Develop and implement utilization management strategies that align with organizational goals. + ... care. **Cost Containment:** + Identify opportunities for cost savings through effective utilization management practices. + Monitor and analyze utilization … more
- CenterWell (Louisville, 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)
- …internal meetings. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse (RN). **Required Experience** 1-3 years of hospital ... requests for transplants; the ideal candidate will have experience either in utilization review or case management for transplants. Preference will be… more
- HCA Healthcare (Frankfort, KY)
- …Life Support must be obtained within 30 days of employment start date + Registered Nurse + Bachelors Degree or higher Frankfort Regional Medical Center ... of care for patients with sepsis/septic shock and functions as a performance management and improvement educator and coach for hospital and medical staff to ensure… more
- Highmark Health (Frankfort, KY)
- …Master's degree in Business or Clinical field **LICENSES or CERTIFICATIONS** **Required** + Registered Nurse (RN) or Pharmacist (Pharm D) or Physician Assistant ... **SKILLS** + Deep Clincal Expertise -extensive knowledge of clinical, quality, care, utilization , high-cost claim, and population health management . Must be a… more