- CVS Health (Frankfort, KY)
- …FOR LICENSING DETAILS_** This is a fulltime remote Utilization Management Clinical Consultant opportunity with Aetna Better Health of Kentucky. ... 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
- CenterWell (Frankfort, KY)
- …UM Administration Coordinator - Phone Intake contributes to administration of utilization management . The UM Administration Coordinator performs varied ... best care, when needed most, and for the lowest cost. We go beyond physical health - addressing the social, emotional, behavioral and financial needs that can… more
- CVS Health (Frankfort, KY)
- …and practices. + Responsibility for cross-functional integration of care and case management , utilization management , program operations with core ... the project implementation goals. + Consulting and supporting the utilization management processes by encouraging the use...activities with key staff for enhanced integration of physical health and behavioral health services… more
- BrightSpring Health Services (Louisville, KY)
- …pharmacy, home health care and primary care, and rehabilitation and behavioral health , we provide comprehensive and more integrated care and clinical ... Our Company BrightSpring Health Services Overview Clinical Denials Management ...as a nurse + Two years of experience in health care utilization review or home care… more
- Highmark Health (Frankfort, KY)
- …Description :** **JOB SUMMARY** This job implements effective ** utilization management ** strategies including: review of appropriateness of health care ... 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
- Elevance Health (Louisville, KY)
- …an equivalent background. + For Health Solutions and Carelon organizations (including behavioral health ) only, minimum of 5 years of experience providing ... and overseeing clinical/non-clinical activities. Will also be responsible for utilization review/ management . May be responsible for developing and… 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
- CenterWell (Louisville, KY)
- …that impact patient well-being. Our integrated care teams, which include physicians, nurses, behavioral health specialists and more, spend up to 50 percent more ... part of our caring community and help us put health first** The Market CMO serves as a ...expertise. + Develop, implement and monitor the outcomes of utilization review and disease management programs to… more
- Highmark Health (Frankfort, KY)
- **Company :** Highmark Health **Job Description :** Entirely Remote Work From Anywhere Role! We are seeking an experienced Software Engineering Manager to lead our ... Join us and build the future of AI! **ESSENTIAL RESPONSIBILITIES** + Perform management responsibilities to include, but are not limited to: involved in hiring and… 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 (Louisville, 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