Licensed Utilization Review I

4 days ago

Louisville, United States Elevance Health Full time

The Licensed Utilization Review I is responsible for working with healthcare providers to help ensure appropriate and consistent administration of plan benefits through collecting clinical information to preauthorize services, assess medical necessity, out of network services, and appropriateness of treatment setting and applying appropriate medical policies, clinical guidelines, plan benefits, and/or scripted algorithms within scope of licensure. Location: The ideal candidate will reside in Kentucky. How you will make an impact: Conducts pre-certification, inpatient (if not associated with CM or DM triage) retrospective, out of network and appropriateness of treatment setting reviews within scope of licensure by utilizing appropriate medical policies and clinical guidelines in compliance with department guidelines and consistent with the members eligibility, benefits and contract. Develops relationships with physicians, healthcare service providers, and internal and external customers to help improve health outcomes for members. Applies clinical knowledge to work with facilities and providers for care coordination. May access and consult with peer clinical reviewers, Medical Directors and/or delegated clinical reviewers to help ensure medically appropriate, quality, cost effective care throughout the medical management process. Educates the member about plan benefits and contracted physicians, facilities and healthcare providers. Refers treatment plans/plan of care to peer clinical reviewers in accordance with established criteria/guidelines and does not issue medical necessity non-certifications. Facilitates accreditation by knowing, understanding, and accurately applying accrediting and regulatory requirements and standards. Minimum Requirements: Requires a HS diploma or equivalent and a minimum of 2 years of clinical or utilization review experience; or any combination of education and experience, which would provide an equivalent background. Current active unrestricted license or certification as a LPN, LVN, or RN to practice as a health professional within the scope of licensure in applicable state(s) or territory of the United States required. Preferred Skills, Capabilities, and Experiences: Knowledge of the medical management process strongly preferred. Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance.

  • Licensed Utilization Review I

    2 weeks ago

    Louisville, United States Elevance Health Full time

    Anticipated End Date: 2025-02-24 Position Title: Licensed Utilization Review I Job Description: The Licensed Utilization Review I is responsible for working with healthcare providers to help ensure appropriate and consistent administration of plan benefits through collecting clinical information to preauthorize services, assess medical necessity, out of...

  • RN Utilization Review Specialist

    3 weeks ago

    Louisville, Kentucky, United States UofL Health Full time

    Job SummaryWe are seeking a skilled RN Utilization Review Specialist to join our team at UofL Health. As a key member of our Utilization Management team, you will play a critical role in ensuring the delivery of high-quality, patient-centered care while promoting optimal health outcomes and financial accountability.ResponsibilitiesConduct admission and...

  • Utilization Review Coordinator, Behavioral Health

    4 weeks ago

    Louisville, Kentucky, United States UofL Health Full time

    Job SummaryThe Utilization Review Coordinator plays a critical role in supporting the Utilization Management functions at UofL Health. This position is responsible for delivering the Utilization Management process, including making clinical recommendations regarding medical necessity for admission and continued stay, screening patients for client-specific...

  • Utilization Management Representative I

    2 months ago

    Louisville, United States Elevance Health Full time

    Title: Utilization Management Representative I Location: This position will work a hybrid model (remote and office). Ideal candidates will live within 50 miles of one of our PulsePoint locations. The Utilization Management Representative I will be responsible for coordinating cases for precertification and prior authorization review. How you will make an...

  • Insurance Account Manager

    4 weeks ago

    Louisville, Kentucky, United States Big I Kentucky Full time

    {"Responsibilities": "Key Responsibilities:Identify and develop personal insurance opportunities with new and existing clients through various channels, including in-person, online, phone, and written communication.Foster and maintain strong relationships with clients and prospects through regular follow-up, accurate and timely quotations, and general...

  • Insurance Account Manager

    4 weeks ago

    Louisville, Kentucky, United States Big I Kentucky Full time

    {"title": "Customer Service Representative", "description": "Job SummaryAs a Customer Service Representative at Big I Kentucky, you will play a vital role in maintaining strong customer relationships by providing exceptional service and support. Your primary responsibility will be to handle customer inquiries and concerns with speed and professionalism,...

  • Unit Manager I

    4 weeks ago

    Louisville, Kentucky, United States Seven Counties Services Full time

    Job Title: Unit Manager ISeven Counties Services is seeking a highly skilled and experienced Unit Manager I to join our team. As a Unit Manager I, you will be responsible for supervising and directing the activities of an assigned unit, ensuring quality services and care are provided to clients within budgetary limits and established regulations, policies,...

  • Utility Trainee

    2 weeks ago

    Louisville, Kentucky, United States Louisville Metropolitan Sewer District Full time

    **Key Responsibilities:**As a Utility Trainee with the Louisville Metropolitan Sewer District, you will be responsible for assisting in the operation and maintenance of drainage systems. This role requires a Class A CDL with N endorsement, which will be promoted to Utility Worker I ($21.34/hour) upon completion of training requirements.**Training and...

  • CDL Utility Driver

    2 months ago

    Louisville, United States Rumpke of Ohio, Inc. Full time

    Description CDL Utility Drivers are responsible for servicing customers with the collection and hauling of waste or recycling materials to a disposal site or recycling plant. This position requires the ability to operate various types of trucks and be able to fill in for other drivers. Drivers will service many different routes in various areas and operate...

  • Clinical Review Nurse Sr

    5 days ago

    Louisville, United States Elevance Health Full time

    Anticipated End Date: 2024-11-21 Position Title: Clinical Review Nurse Sr Job Description: Clinical Review Nurse Sr. National Government Services is a proud member of Elevance Health's family of brands. We administer government contracts for Medicare and partner with the Centers for Medicare and Medicaid Services to transform federal health...

  • Taxpayer Services Specialist I

    2 weeks ago

    Louisville, Kentucky, United States Kentucky Personnel Cabinet Full time

    Job SummaryWe are seeking a highly motivated Taxpayer Services Specialist I to join our team at the Kentucky Department of Revenue. As a Taxpayer Services Specialist I, you will be responsible for providing clear communication and negotiation skills with taxpayers and their representatives over the phone and in person to resolve tax matters.Responsibilities...

  • Electrical Utility Drafter

    4 weeks ago

    Louisville, Kentucky, United States Actalent Full time

    Job Title: Katapult DrafterJob OverviewActalent is seeking a skilled Katapult Drafter to join our team in Louisville, Kentucky. As a key member of our engineering team, you will be responsible for designing, drafting, and updating maps of communication utilities using Katapult imagery. Your expertise will be essential in interpreting and reproducing field...

  • Patient Services Representative I

    3 weeks ago

    Louisville, Kentucky, United States MAKO Medical Full time

    Job SummaryThe Patient Services Representative I (PSR I) is a vital member of the MAKO Medical team, responsible for providing exceptional patient care and ensuring the smooth operation of our laboratory services.The PSR I will draw quality blood samples from patients and prepare those specimens for lab testing, while adhering to established protocols and...

  • Geologist I+

    3 weeks ago

    Louisville, Kentucky, United States Atlas Technical Consultants, Inc. Full time

    Geologist I+ Job DescriptionAtlas Technical Consultants, Inc. is seeking a highly skilled Geologist I+ to join our team in Louisville, KY. As a Geologist I+, you will be responsible for conducting field and laboratory tests, relaying information to project managers and engineers, and performing various tasks related to soil and aggregate testing.Key...

  • Clinical Utilization Management Specialist

    3 weeks ago

    Louisville, Kentucky, United States Elevance Health Full time

    Job Summary: We are seeking a skilled Clinical Utilization Management Specialist to join our team at Elevance Health. As a key member of our healthcare team, you will play a vital role in promoting quality member outcomes, optimizing member benefits, and ensuring effective use of resources for complex medical issues. Key Responsibilities: Conducts...

  • Maintenance Technician I

    2 weeks ago

    Louisville, Kentucky, United States PRG Real Estate Management Inc Full time

    Maintenance Technician I Job DescriptionThe Maintenance Technician I is a key member of our team at PRG Real Estate Management Inc, responsible for ensuring the upkeep and maintenance of our properties. This role involves assisting in the completion of service requests, restoring vacant apartments to market-ready status, and performing general upkeep of...

  • Insurance Account Manager

    4 weeks ago

    Louisville, Kentucky, United States Big I Kentucky Full time

    Job Title: Insurance Account ManagerJob Summary:We are seeking a highly skilled Insurance Account Manager to join our team at Big I Kentucky. As a key member of our organization, you will be responsible for providing exceptional client service, managing client relationships, and driving business growth.Key Responsibilities:Manage client relationships and...

  • Unit Manager I

    4 weeks ago

    Louisville, Kentucky, United States Seven Counties Services Full time

    Job Summary:The Unit Manager I is responsible for supervising and directing clinical and/or prevention and administrative personnel. This includes scheduling and coordinating activities, conducting performance reviews, providing training, and implementing unit programming. The successful candidate will have a Master's degree in Education, Counseling, or a...

  • Claims Service Specialist

    2 weeks ago

    Louisville, Kentucky, United States Big I Kentucky Full time

    Job SummaryWe are seeking a highly skilled Claims Service Specialist to join our team at Big I Kentucky. As a Claims Service Specialist, you will be responsible for providing exceptional customer service to our clients, supporting various areas within Business Insurance Claims, and ensuring seamless claim processing.Key ResponsibilitiesCounsel clients on...

  • Norton Hospital Registered Nurse

    4 weeks ago

    Louisville, Kentucky, United States Norton Healthcare Full time

    Job Title:Registered Nurse - Telemetry IJob Specialty:Telemetry - OrthopedicJob Summary:Norton Healthcare is seeking a skilled Registered Nurse to join our team in the Telemetry unit. As a Registered Nurse - Telemetry I, you will provide high-quality patient care to patients with various medical conditions, including orthopedic and telemetry care....