- CVS Health (Frankfort, KY)
- …active current and unrestricted RN licensure in state of residence. + Utilization Management is a 24/7 operation and work schedules will include weekends, ... **Required Qualifications** + 2+ years of experience as a Registered Nurse in adult acute care/critical care...or specialty area. + Managed Care experience preferred, especially Utilization Management . + Preference for those residing… more
- Signature Healthcare (Louisville, KY)
- …Care documentation to facility accurate billing. What you Need to make a Difference + Registered Nurse ( RN ) in good standing with required current state ... communication with leadership, patients, families, internal care givers, and external Utilization Management Nurses. + Coordinate internal and external health… more
- AdventHealth (Manchester, KY)
- …or Clay County depending on RN . **The role you'll contribute:** The Home Health Registered Nurse ( RN ) Care Manager is a professional nurse who ... and directs the home care patient's care based on individual patient needs. The RN Care Manager is responsible for independent management of the Home Health… more
- Fresenius Medical Center (Mount Sterling, KY)
- …Classification of Disease (ICD) coding. + Manages clinic financials including efficient utilization of supplies or equipment and regular profits and loss review. + ... of education and experience. + Graduate of an accredited School of Nursing ( RN ). + Current appropriate state licensure. **EXPERIENCE AND SKILLS:** + Required: + 6+… more
- Sharecare (Frankfort, KY)
- …cost effective, appropriate resource utilization and quality outcomes. The Clinical Registered Nurse is also responsible for early identification of those ... according to the disease management program intervention guidelines. A Clinical Registered Nurse is supervised by an Operations Manager (OM). All Sharecare… more
- Bon Secours Mercy Health (Paducah, KY)
- …partnership * Interprofessional collaboration and leadership * Understanding and utilization of office and clinical technologies * Compassionate, relationship-based ... for professional actions * Effective stewardship of available resources * Conflict management and resilience * Authority for delegating activities to others, while… more
- CVS Health (Frankfort, KY)
- …care. + Perform medical necessity reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse ( RN ) with at least 1 year of experience ... is URAC accredited in Case Management , Disease Management and Utilization Management . AHH...in a hospital setting. + A Registered Nurse that holds an active, unrestricted… more
- Jennie Stuart Medical Center, Inc. (Hopkinsville, KY)
- The RN working in L/D is responsible for promoting...be licensed by the state of Kentucky as a Registered Nurse , as well as NRP/BLS/ACLS certified. ... conducting medical screens on patients presenting to L/D for monitoring/observation. The RN has knowledge of the admission, discharge, transfer and fetal monitoring… more
- Molina Healthcare (Bowling Green, 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
- Highmark Health (Frankfort, KY)
- …Nursing **EXPERIENCE** **Required** + 7 years in any combination of clinical, case/ utilization management and/or disease/condition management experience, or ... required depending on where clinical care is being provided. **Preferred** + Certification in utilization management or a related field + Certification in Case … more