- CVS Health (Frankfort, KY)
- …Must have active current and unrestricted RN licensure in state of residence. + Utilization Management is a 24/7 operation and work schedules will include ... med surg or specialty area. + Managed Care experience preferred, especially Utilization Management . + Preference for those residing in EST and CST zones.… 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)
- …SEE REQUIRED QUALIFICATIONS FOR LICENSING DETAILS_** This is a fulltime remote Utilization Management Clinical Consultant opportunity with Aetna Better Health of ... clinical skills to coordinate, document and communicate all aspects of the utilization /benefit management program. + Applies critical thinking and is… more
- Veterans Affairs, Veterans Health Administration (Lexington, KY)
- Summary The Registered Nurse Transfer coordinator is directly responsible for the facilitation and monitoring of the community hospital referrals to the VA facility, ... for collaborating with other staff for appropriate oversight and management of emergency care received through community hospitals. Responsibilities Duties… 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 ... **Oncology or Specialty Pharmacy** **.** **Preferred Qualifications** + 1+ years' Case Management experience or discharge planning, nurse navigator or nurse… more
- HCA Healthcare (Frankfort, KY)
- …effective labor management , including position control, scheduling excellence, productivity management , and premium pay utilization to maintain staffing to ... United Kingdom. We are looking for a Critical Care Nurse Director for our Frankfort Regional Medical Center team...the effectiveness on an ongoing basis. + Implement Emergency Management Plan and Patient Safety Initiatives. + Coordinate the… more
- Molina Healthcare (Lexington, KY)
- …contained in the delegation agreement. **KNOWLEDGE/SKILLS/ABILITIES** The Delegation Oversight Nurse is responsible for ensuring that Molina Healthcare's UM ... as well as Molina Healthcare business needs. In addition, the Delegation Oversight Nurse will assist the Delegation Oversight Manager with additional duties of the… more
- Molina Healthcare (Lexington, 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
- Sharecare (Frankfort, KY)
- …total healthcare management and ensure cost effective, appropriate resource utilization and quality outcomes. The Clinical Registered Nurse is also ... the participants and their Primary Care Provider according to the disease management program intervention guidelines. A Clinical Registered Nurse is supervised… more
- Lincoln Financial (Frankfort, KY)
- …Care, Orthopedics, Coronary Care, , Trauma , Disability, Workman's comp or case management or Utilization review **Application Deadline** **What's it like to ... Role at a Glance** We are excited to bring on a highly motivated Nurse Disability Consultant to our clinical organization. This position will be responsible for… more
- Fresenius Medical Center (Lexington, 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
- United Therapeutics (Frankfort, KY)
- …for which transplant is not currently an option. Who you are You are experienced nurse and an expert in all things PAH. You love providing mentorship, coaching and ... make a difference. The Regional Field Director, RNS Program Management serves as a director of all clinical field...+ Plan, collaborate, create and produce the yearly Clinical Nurse Summit meeting for HCPS across the United States… more
- Molina Healthcare (Lexington, KY)
- … and effective resource management . + Develops and implements a Utilization Management program and action plan, which includes strategies that ensure ... IT and data analysts to produce tools to report, monitor and improve Utilization Management . + Actively participates in regulatory, professional and community… 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 (Lexington, KY)
- …driver's license, auto insurance and reliable transportation. + Two years as a Registered Nurse with at least one-year of management experience in a home care, ... review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and conducts… more
- Veterans Affairs, Veterans Health Administration (Lexington, KY)
- …specialty care. Coordinates with the patient care team to review the clinic utilization by using various reports (eg, Clinic Utilization Statistical Summary). ... effective and efficient communication with the patient, interdisciplinary team, management team, VA medical centers, and other agencies. Collect, scans,… more
- Catholic Health Initiatives (Lexington, KY)
- …JOB FUNCTIONS:** Identifies pertinent patient data as it relates to weight management bariatric surgery and collaborates with a multi-disciplinary team. Quality ... Management - Extracts patient data from medical charts using...follow-up data components for the program through the effective utilization of the hospital medical record systems and through… more
- Molina Healthcare (Lexington, KY)
- …requests for transplants; the ideal candidate will have experience either in utilization review or case management for transplants. Preference will be ... **JOB DESCRIPTION** Opportunity for experienced Utilization Review RN in United States who has...**JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse (RN). **Required Experience** 1-3 years of hospital or… more
- BrightSpring Health Services (Lexington, KY)
- …devises and executes on value-based strategies for the state to include utilization management and attribution strategies + Direct patient care responsibilities ... dashboards + Provides collaborating physician duties for on average of 5 nurse practitioners and physician assistants (based on state regulatory parameters) to… more
- HCA Healthcare (Frankfort, KY)
- …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 ... optimal care management and outcomes. The Coordinator collects, analyzes data and...of care. This position identifies best practices and promotes utilization of such within the organization. + Systematically evaluates… more