- Humana (Frankfort, KY)
- …help us put health first** Humana Healthy Horizons in Kentucky is seeking a Utilization Management Behavioral Health Professional 2 who utilizes ... and communication of medical services and/or benefit administration determinations. The Utilization Management Behavioral Health Professional… more
- CVS Health (Frankfort, KY)
- …every day. **Position Summary** This is a fulltime remote Utilization Management Clinical Consultant opportunity with Aetna Better Health of Kentucky. This ... /benefit management function. **Required Qualifications** + Kentucky Licensed Independent Behavioral Health Clinician ( LPCC, LCSW, LMFT, LPAT ) -… more
- CVS Health (Frankfort, KY)
- …meetings when requested * Oversight and implementation of the utilization management program for behavioral health services, including preventing ... health plan. They will have key roles in utilization management and case management ...development of clinical practice standards, policies, and procedures * Behavioral health care management performance… more
- Molina Healthcare (Lexington, KY)
- …equivalent experience * 2 or more years in case, disease, or utilization management ; managed care; or medical/ behavioral health settings. * Proficient in ... development, implementation, and collaboration with the delivery of training curriculum for Utilization Management , Case Management , and LTSS staff. **Job… more
- Highmark Health (Frankfort, KY)
- …of clinical, case/ utilization management and/or disease/condition management experience, or provider operations and/or health insurance experience ... health status/severity and clinical needs; and assesses health management needs of the assigned member...clinical care is being provided. **Preferred** + Certification in utilization management or a related field +… more
- Highmark Health (Frankfort, KY)
- …Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of health care services, ... utilization , identification of opportunities for referral to a Health Coach/case management , and identification and resolution...position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of… more
- Highmark Health (Frankfort, KY)
- …:** **JOB SUMMARY** This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and ... (DO) **Substitutions** + None **Preferred** + Master's Degree in Business Administration/ Management or Public Health **EXPERIENCE** **Required** + 5 years… more
- Highmark Health (Frankfort, KY)
- **Company :** Highmark Health **Job Description :** **JOB SUMMARY** This job will manage small scale projects and enhancement packages with mentorship and leadership ... from more senior Delivery Owners. The incumbent provides project management leadership and facilitates the delivery of system changes from approval through to… more
- Highmark Health (Frankfort, KY)
- …portfolio of AI-powered products, including a core administrative platform, modular utilization and care management solutions, patient-focused digital products, ... Marketing qualified leads and sales qualified leads. + Opportunity Pipeline Management : Manage and forecast the sales pipeline, providing accurate revenue… more
- Highmark Health (Frankfort, KY)
- …familiarity with key domains like CMS interoperability, Quality management , care & utilization management , and digital health + 3 years' experience in ... brand visibility, market intelligence, etc.) + Proposal & RFP Management : + Support proposal development timelines, coordinate input across...from lead to closure) + 3 years' experience in Health Plan Technology + 3 years' experience with solid… more
- Centene Corporation (Frankfort, KY)
- …licensed Psychologist with a Kentucky license with a passion for improving access to behavioral health care? Centene is looking for a Remote Psychologist to ... appeals, and occasional peer-to-peer consultations, as well as participating in Utilization Management clinical rounds.** **We're seeking candidates who:** +… more
- Highmark Health (Frankfort, KY)
- **Company :** Highmark Health **Job Description :** **JOB SUMMARY** This job is a strong advocate of cloud technology and engineering support necessary to drive the ... to senior or lead engineers to further cloud service utilization and optimization. + Develops automation scripts and other...of action. + Level 2 Incident, problem and change management as it pertains to the responsibilities of the… more
- Highmark Health (Frankfort, KY)
- …knowledge of clinical, quality, care, utilization , high-cost claim, and population health management . Must be a recognized subject matter expert (SME). + ... job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of...with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as… more
- CenterWell (Frankfort, KY)
- …care that affect patient care and population management , such as quality management , utilization management , network management , and payment ... that impact patient well-being. Our integrated care teams, which include physicians, nurses, behavioral health specialists and more, spend up to 50 percent more… more
- Centene Corporation (Frankfort, KY)
- …BCBA certification to support our growing markets and ensure high-quality, evidence-based behavioral health care.** **Why Join Us?** + **100% remote ... to clinical excellence** **Position Purpose:** Authorize, direct and monitor care for behavioral health and substance abuse problems according to clinical… more
- HCA Healthcare (Frankfort, KY)
- …services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed ... effective labor management , including position control, scheduling excellence, productivity management , and premium pay utilization to maintain staffing to… more
- Molina Healthcare (Lexington, KY)
- …plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care, for members with high need potential. ... transplants; the ideal candidate will have experience either in utilization review or case management for transplants. Preference will be given to those whose… more
- Sharecare (Frankfort, KY)
- …of the health care team to support appropriate total healthcare management and ensure cost effective, appropriate resource utilization and quality outcomes. ... team. Facilitates communication exchange with primary managing physician and other providers, health plan, and the disease management program team. + Coordinates… more
- HCA Healthcare (Frankfort, KY)
- …services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed ... Center, offers a total rewards package that supports the health , life, career and retirement of our colleagues. The...patients with sepsis/septic shock and functions as a performance management and improvement educator and coach for hospital and… more
- Humana (Frankfort, KY)
- …broad range of clinical conditions and disease states - experience with oncology, behavioral health and chronic conditions would be particularly valuable **Use ... **Become a part of our caring community and help us put health first** Humana's Clinical Analytics Team is seeking a **Research Scientist (Remote).** Healthcare is… more