Emergency Medicine Medical Director Sound Inpatient Physicians Holdings, LLCEmergency Medicine Medical DirectorRadcliff, KYHow telemedicine can transform sepsis care in long-term facilities Discover how telemedicine is transforming sepsis care in long-term facilities-delivering faster intervention, better outcomes, and peace of mind for patients and providers. CategorySelectAnesthesiologyBusiness DevelopmentClinical SupportComplianceCritical CareData & AnalyticsEmergency MedicineFinanceHospital MedicineNursingPediatricPost Acute / Transitional CareRevenue CycleSite AdministrationTelemedicine.
REMOTE - Vice President Medical Director of Clinical Programs Martin's Point Health Care LLCREMOTE - Vice President Medical Director of Clinical ProgramsKYRemoteHMO/Managed Care experience, including Utilization and/or Quality Program management and exposure to peer review, case management, population health, appeals, chronic and complex disease management, HEDIS reporting, and provider relations. In collaboration with the MPHC Chief Medical Officer (CMO), advocates with government/state regulatory entities, professional and medical society chapters, federal regulators/contactors, and as part of external communications and media relations to advance HP's clinical value story, evidence-based medical policies, and member health.
Senior Medical Director Medicaid CVS Health CorpSenior Medical Director MedicaidKY$184,112–$396,550 / yearAetna operates Medicaid Managed Care Plans in multiple states: Arizona, Florida, Illinois, Kentucky, Louisiana, Maryland, Michigan, New Jersey, New York, Ohio, Oklahoma, Pennsylvania, Texas, Virginia and West Virginia. Responsible for recommending changes and enhancements to current managed care, review guidelines, and clinical criteria based on extensive knowledge of health care delivery systems, utilization methods, reimbursement methods, and treatment protocols.
Behavioral Health Medical Director - AI Policy & Governance CVS Health CorpBehavioral Health Medical Director - AI Policy & GovernanceKY$174,070–$374,920 / yearRole summary: The Behavioral Health (BH) Medical Director (MD) for AI Policy & Governance provides clinical leadership to ensure artificial intelligence (AI)including predictive models and generative AIis designed, validated, implemented, and monitored in ways that are clinically sound, ethical, safe, compliant, and equitable. -Ensure equitable performance across populations (e.g., depending on how model was trained, training data may not always be representative), identify and mitigate algorithmic bias in care decisions; align AI deployment with organizational values and patient trust.
Medical Director - OneHome Humana IncMedical Director - OneHomeKYRemote$223,800–$313,100 / yearTo ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is required. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it.
Chief Medical Officer BrightSpring Health ServicesChief Medical OfficerLOUISVILLE, KYThe CMO is responsible for the strategic direction and oversight of clinical programs including utilization management, clinical operations, quality, population health, and pharmacy operations to ensure safe, effective, and financially responsible care for members in long term care settings. The CMO serves as the senior physician executive, partnering with the CEO and leadership team to drive clinical performance, regulatory compliance, and an integrated model of care for high-acuity, medically complex populations.
Medical Director MPO CVS Health CorpMedical Director MPOKY$174,070–$374,920 / yearIn this role as Medical Director MPO (Medical Policy & Operations) you will be responsible for providing clinical expertise to promote the delivery of high quality, constituent focused medical care with a focus on clinical and payment policy. Additional responsibilities may include: Participate on work groups as a clinical subject matter expert to identify and promote opportunities to improve the quality and efficiency of health care services.
Medical Director - Medicare Fee for Service Elevance Health IncMedical Director - Medicare Fee for ServiceLouisville, KYp>Minimum Requirements: Requires MD/DO and Board certification approved by one of the following certifying boards is required, where applicable to duties being performed, American Board of Medical Specialties (ABMS) or American Osteopathic Association (AOA). Preferred Skills, Capabilities, and Experiences: Strong oral, written, and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
Medical Director, PACE Senior CommUnity Care and UofL Physicians U of L PhysiciansMedical Director, PACE Senior CommUnity Care and UofL PhysiciansLouisville, KYMust have experience working in a managed care environment and working with peers and other health providers to resolve utilization, quality management, performance improvement, pharmacy and therapeutics, peer review, credentialing, and physician leadership issues. The Medical Director supports and directs Senior CommUnity Care medically-related committee work, provides primary care to all participants of the PACE program and works independently in the application of advanced physician knowledge and skills.
Medical Director Volunteers of America National ServicesMedical DirectorLouisville, KentuckyMust have experience working in a managed care environment and working with peers and other health providers to resolve utilization, quality management, performance improvement, pharmacy and therapeutics, peer review, credentialing, and physician leadership issues. The Medical Director objective is to provide direction to Senior CommUnity Care related to the medical delivery of care by providers and ensures the delivery of quality health care services.
Medical Director, PACE Senior CommUnity Care and UofL Physicians UofL HealthMedical Director, PACE Senior CommUnity Care and UofL PhysiciansLouisville, KentuckyMust have experience working in a managed care environment and working with peers and other health providers to resolve utilization, quality management, performance improvement, pharmacy and therapeutics, peer review, credentialing, and physician leadership issues. The Medical Director supports and directs Senior CommUnity Care medically-related committee work, provides primary care to all participants of the PACE program and works independently in the application of advanced physician knowledge and skills.
Medical Director Concentra Inc.Medical DirectorLouisville, KYSpends 100% of time in the onsite clinic providing direct patient care, leading by example, and creating an exceptional patient experience Ensures day-to-day execution of Concentra's clinical model collaborating with members of the healthcare team to drive optimal clinical outcomes Accountable for monitoring, understanding, and effecting key onsite clinic metrics that relate to quality outcomes of Advanced Primary Care - chronic condition management, gaps in care, preventive health and age appropriate screenings, vaccinations, SDOH, wellness initiatives, clinic utilization and patient satisfaction of Occupational Medicine - timely return to work measures after an injury on the job, case duration, lost time, work duty status, reduction in work-related illnesses and improved functional capacity. Manages staff clinicians and support staff and complies with APC supervisory requirements Creates a professional and collaborative working environment with full colleague participation that promotes teamwork, quality, exceptional outcomes, and patient and colleague safety and engagement Works with DMO and onsite leadership to identify and implement changes to ensure continuous clinical improvement Masters use of clinical systems to ensure efficiency, excellent supportive documentation, and follow-through on all patient care orders Ensures compliance with local, State, and Federal Practice Act/Rules and Regulations/WC Regulations Drives patient and client experience metrics.
Medical Director, PACE Senior CommUnity Care and UofL Physicians University of Louisville Physicians IncMedical Director, PACE Senior CommUnity Care and UofL PhysiciansLouisville, KYAddress: 204 E. Market Street Suite 103 Louisville, KY 40202 Shift: Job Description Summary: UofL Health is a fully integrated regional academic health system with five hospitals, four medical centers, nearly 200 physician practice locations, more than 700 providers, the Frazier Rehab Institute and Brown Cancer Center. Working knowledge of health care delivery and financing systems, including Medicaid, Medicare, waiver programs, prospective and capitated systems, public health programs and Health Management Organizations/Managed Care.
Medical Director Senior Community Care of KentuckyMedical DirectorLouisville, KYFull timeMust have experience working in a managed care environment and working with peers and other health providers to resolve utilization, quality management, performance improvement, pharmacy and therapeutics, peer review, credentialing, and physician leadership issues. The Medical Director objective is to provide direction to Senior CommUnity Care related to the medical delivery of care by providers and ensures the delivery of quality health care services.
NewChief Medical Director, MD/DO Senior Community Care of KentuckyChief Medical Director, MD/DOLouisville, KYMust have experience working in a managed care environment and working with peers and other health providers to resolve utilization, quality management, performance improvement, pharmacy and therapeutics, peer review, credentialing, and physician leadership issues. The Medical Director objective is to provide direction to Senior CommUnity Care related to the medical delivery of care by providers and ensures the delivery of quality health care services.
NewMedical Director, MD Senior Community Care of KentuckyMedical Director, MDLouisville, KYMust have experience working in a managed care environment and working with peers and other health providers to resolve utilization, quality management, performance improvement, pharmacy and therapeutics, peer review, credentialing, and physician leadership issues. The Medical Director objective is to provide direction to Senior CommUnity Care related to the medical delivery of care by providers and ensures the delivery of quality health care services.
NewChief Medical Director, MD Senior Community Care of KentuckyChief Medical Director, MDLouisville, KYMust have experience working in a managed care environment and working with peers and other health providers to resolve utilization, quality management, performance improvement, pharmacy and therapeutics, peer review, credentialing, and physician leadership issues. The Medical Director objective is to provide direction to Senior CommUnity Care related to the medical delivery of care by providers and ensures the delivery of quality health care services.
NewChief Medical Director Senior Community Care of KentuckyChief Medical DirectorLouisville, KYMust have experience working in a managed care environment and working with peers and other health providers to resolve utilization, quality management, performance improvement, pharmacy and therapeutics, peer review, credentialing, and physician leadership issues. The Medical Director objective is to provide direction to Senior CommUnity Care related to the medical delivery of care by providers and ensures the delivery of quality health care services.
NewMedical Director, MD/DO Senior Community Care of KentuckyMedical Director, MD/DOLouisville, KYMust have experience working in a managed care environment and working with peers and other health providers to resolve utilization, quality management, performance improvement, pharmacy and therapeutics, peer review, credentialing, and physician leadership issues. The Medical Director objective is to provide direction to Senior CommUnity Care related to the medical delivery of care by providers and ensures the delivery of quality health care services.
Medical Director, Behavioral Health Molina Healthcare IncMedical Director, Behavioral HealthLouisville, KYCertified Professional in Healthcare Management (CPHM), Certified Professional in Health Care Quality (CPHQ), Commission for Case Manager Certification (CCMC), Case Management Society of America (CMSA) or other health care or management certification. JOB DESCRIPTION Job SummaryProvides medical oversight and expertise related to behavioral health and chemical dependency services, and assists with implementation of integrated behavioral health care programs within specific markets/regions.
NewGeneral Practice Care - Medical Director - Crestwood, KY UsvtaGeneral Practice Care - Medical Director - Crestwood, KYCrestwood, KentuckyAn exceptional veterinary hospital, with a dedicated team, is seeking an experienced Medical Director to provide leadership, oversee medical operations, and ensure superior patient and client care to members of its community. This hospital is open to considering experienced veterinarians who are prepared to take on a senior leadership role, overseeing medical operations and working collaboratively with the practice manager.
Medical Director - Surgery Elevance Health IncMedical Director - SurgeryKYWe 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. Provides support and education to internal clinical and non-clinical staff regarding the principles associated with appropriate diagnoses, treatments, and management of conditions and surgical procedures.
Louisville Medical Director | Primary Care | $360k+ Optigy GroupLouisville Medical Director | Primary Care | $360k+Louisville, KENTUCKY$280,000–$300,000 / yearTo support continued growth, our client is seeking high-caliber primary care physicians and clinical leaders who are motivated by purpose, professional development, and the opportunity to make a meaningful impact in the lives of patients and communities. Our client is a physician-led, mission-driven primary care organization dedicated to transforming healthcare for seniors through high-quality, value-based care.
NewPediatric Medical Director of Echocardiography Norton Medical GroupPediatric Medical Director of EchocardiographyLouisville, KYli>Institute participates in numerous national registries and collaboratives, including the Society of Thoracic Surgeons, Congenital Heart Surgeons Society, Pediatric Cardiac Critical Care Consortium (PC4) and National Pediatric Cardiology-Quality Improvement Collaborative. Norton Childrens Hospital and Novak Center for Childrens Health are accredited Adult Congenital Heart Disease (ACHD) Comprehensive Care .
Medical Director American Red Cross Blood ServicesMedical DirectorKY$165,000–$185,000 / yearAmeriCorps, the federal agency that brings people together through service, and its partners - the Peace Corps, AmeriCorps Alums, National Peace Corps Association, and the Service Year Alliance - launched Employers of National Service to connect national service alumni with opportunities in the workforce. Combination of candidate's education and general experience satisfies requirements so long as the total years equate to description's minimum education and general experience years combined (Management experience cannot be substituted).
Behavioral Health Medical Director - ABH KY CVS Health CorpBehavioral Health Medical Director - ABH KYKYBenefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. In this role as Medical Director (Behavioral Health), you will: Provide leadership and day-to-day physician oversight for utilization management team, including the management of high-risk cases and medical necessity decisions.
NewJoin our Transformational Model as a Center Medical Director | Louisville, KY ChenMed Family of CompaniesJoin our Transformational Model as a Center Medical Director | Louisville, KYLouisville, KYli>Dedicated in-house staff and specialists, including nursing services, case managers, social workers, cardiologists, podiatrists, and more. We are a privately held, physician-led organization and serve our communities through 115+ centers in over 15 states.
Join ChenMed as a Market Medical Director ChenMed Family of CompaniesJoin ChenMed as a Market Medical DirectorLouisville, KYTeam Collaboration: Work closely with the Division President and Market General Management and other leadership to manage day-to-day operations and improve financial performance. Leadership and Coaching: Lead and mentor your centers clinical team, including primary care providers, to enhance performance and patient care.
Market Clinical Director ChenMedMarket Clinical DirectorShively, Kentucky$270,461–$386,372 / yearPartners with Clinical COE and Talent Acquisition to support clinical talent lifecycle to accelerate Clinical talent growth, including hiring of PCPs, NPs, and Medical Directors, managing, and mentoring physicians, role modeling exemplary clinical leadership. Oversees and facilitates talent development of the PCPs, NPs, and Medical Directors in his/her centers including, but not limited to leading facilitated practice (physician shadowing/coaching), conducting 1:1s with direct reports, executing leadership development plans and performance management.
Emergency Medicine Physician Sound Inpatient Physicians Holdings, LLCEmergency Medicine PhysicianRadcliff, KYHow telemedicine can transform sepsis care in long-term facilities Discover how telemedicine is transforming sepsis care in long-term facilities-delivering faster intervention, better outcomes, and peace of mind for patients and providers. CategorySelectAnesthesiologyBusiness DevelopmentClinical SupportComplianceCritical CareData & AnalyticsEmergency MedicineFinanceHospital MedicineNursingPediatricPost Acute / Transitional CareRevenue CycleSite AdministrationTelemedicine.
Medical Director - Commercial CVS Health CorpMedical Director - CommercialKY$174,070–$374,920 / yearAct as lead business and clinical liaison to network providers and facilities to support the effective execution of medical services programs by the clinical teams. In this role you will: You will participate in the development, implementation, and evaluation of clinical / medical programs and expand Aetna's medical management programs to address member needs across the continuum of care.
Deputy Chief Medical Officer Humana IncDeputy Chief Medical OfficerKYRemote$298,000–$409,800 / yearThe incumbent is responsible for representing Humana's provider perspectives, promoting Medicare Advantage and value-based care initiatives, coordinating and developing the annual value-based care report, supporting advocacy efforts with Corporate Affairs and clinical policy teams, and managing relationships with key external partners such as AAFP, AMA, and the Primary Care Collaborative. Additionally, the incumbent will provide operational leadership in critical areas, including leadership of the Physician Collaborative, Pharmacy and Therapeutics Committee, Public Health and Pandemic Committees, and will represent Humana on the AHIP CMO Committee and with other external partners.
Market Clinical Director at ChenMed – Louisville, KY | Up to $100K Sign-On + J-1 & H-1B Sponsorship ChenMed Family of CompaniesMarket Clinical Director at ChenMed – Louisville, KY | Up to $100K Sign-On + J-1 & H-1B SponsorshipLouisville, KYThis role balances clinical leadership and direct patient care as a Primary Care Physician (PCP), with a key focus on mentoring, developing, and leading your team to deliver exceptional care. Were looking for a passionate Market Clinical Director to lead and inspire a team of Clinical Directors, while ensuring outstanding clinical outcomes across multiple centers within the assigned market.
OB Hospitalist - Director Opportunity - Bardstown OptigyOB Hospitalist - Director Opportunity - BardstownBardstown, KYHighly relational, able to build strong rapport and positive working relationships with all stakeholders (Hospital leadership, hospitalist teams, nurses, staff physicians, and OBHG corporate staff). Will collaborate with the MMD, MDO or VPCO to ensure the clinical team is delivering a quality program that achieves both OBHG's and the hospital's clinical and operational objectives.
OB Hospitalist - Director Opportunity - Bardstown Optigy GroupOB Hospitalist - Director Opportunity - BardstownBardstown, KENTUCKYli>Highly relational, able to build strong rapport and positive working relationships with all stakeholders (Hospital leadership, hospitalist teams, nurses, staff physicians, and OBHG corporate staff). Will collaborate with the MMD, MDO or VPCO to ensure the clinical team is delivering a quality program that achieves both OBHG's and the hospital's clinical and operational objectives.
Medical Review Nurse -UM/Post Appeals (Michigan RN license req) Molina Healthcare IncMedical Review Nurse -UM/Post Appeals (Michigan RN license req)Louisville, KYREQUIRED QUALIFICATIONS: At least 2 years clinical nursing experience, including at least 1 year of utilization review (prospective, retrospective and concurrent clinical review), medical claims review, long-term services and supports (LTSS), claims auditing, medical necessity review and/or coding experience, or equivalent combination of relevant education and experience. Utilizing clinical knowledge and experience, responsible for review of documentation to ensure medical necessity and appropriate level of care utilizing MCG/InterQual, state/federal guidelines, billing and coding regulations, and Molina policies; validates the medical record and claim submitted support correct coding to ensure appropriate reimbursement to providers.
Hospital Medicine Physician Assistant Sound Inpatient Physicians Holdings, LLCHospital Medicine Physician AssistantBardstown, KYp>Discover how Dr. Roderick Fontenettes years in the U.S. Air Force shaped the calm, confident leadership hes known for today as Program Medical Director in the ICU at Adventist Health St. Helena. Discover how telemedicine is transforming sepsis care in long-term facilities-delivering faster intervention, better outcomes, and peace of mind for patients and providers.
Chief Medical Officer - LaGrange Baptist Healthcare System IncChief Medical Officer - LaGrangeKYServing as a trusted ambassador for Baptist Health La Grange, the CMO represents the organization both within the community and across system-wide committees and service lines, strengthening alignment and advancing the mission of delivering outstanding healthcare. The Chief Medical Officer (CMO) plays a pivotal leadership role in building strong, collaborative relationships across the medical staff, executive team, and hospital leadership.
Vice President, Chief Medical Officer - Baptist Health LaGrange Hospital, LaGrange, Kentucky Baptist Health Medical GroupVice President, Chief Medical Officer - Baptist Health LaGrange Hospital, LaGrange, KentuckyLaGrange, KYServing as a trusted ambassador for Baptist Health La Grange, the CMO represents the organization both within the community and across system-wide committees and service lines, strengthening alignment and advancing the mission of delivering outstanding healthcare. The Chief Medical Officer (CMO) plays a pivotal leadership role in building strong, collaborative relationships across the medical staff, executive team, and hospital leadership.
Dialysis Clinical Manager Registered Nurse - RN Fresenius Medical Care AG & Co KGaADialysis Clinical Manager Registered Nurse - RNRadcliff, KYp>Other: Collaborates closely with, providing oversight as needed to, the Clinical Manager/Charge RN acting as nurse manager, the Medical Director, and the physicians regarding the direct patient care responsibilities within the facility to ensure the provision of outstanding quality of patient care, as defined by the FMS quality goals, and compliance with the pertinent company policies and procedures. Demonstrated leadership competencies and management skills for the position, including excellent communication, customer service, continuous quality improvement, relationship development, results orientation, team building, motivating employees, performance management and decision making.
NewDialysis Clinical Manager Registered Nurse - RN Fresenius Medical CareDialysis Clinical Manager Registered Nurse - RNRadcliff, KYOther: • Collaborates closely with, providing oversight as needed to, the Clinical Manager/Charge RN acting as nurse manager, the Medical Director, and the physicians regarding the direct patient care responsibilities within the facility to ensure the provision of outstanding quality of patient care, as defined by the FMS quality goals, and compliance with the pertinent company policies and procedures. • Demonstrated leadership competencies and management skills for the position, including excellent communication, customer service, continuous quality improvement, relationship development, results orientation, team building, motivating employees, performance management and decision making.
Medical Management Nurse Elevance Health IncMedical Management NurseLouisville, KYp>How You Will Make an Impact: Utilizes nursing judgment and reasoning to analyze members' clinical information, interface with healthcare providers, make assessments based on clinical presentation, and apply clinical guidelines and/or policies to evaluate medical necessity. The Medical Management Nurse is responsible for reviewing the most complex or challenging cases that require nursing judgment, critical thinking, and holistic assessment of a member's clinical presentation to determine whether to approve requested service(s) as medically necessary.
Emergency Medicine Nurse Practitioner Sound Inpatient Physicians Holdings, LLCEmergency Medicine Nurse PractitionerRadcliff, KYli/>How telemedicine can transform sepsis care in long-term facilities Discover how telemedicine is transforming sepsis care in long-term facilities-delivering faster intervention, better outcomes, and peace of mind for patients and providers. Specialty Leadership : Advance to senior leadership as Chief Advanced Practice Officer, where you will collaborate with service line leaders to influence organizational programs and lead initiatives that develop team-based care models on a national scale.
Emergency Medicine Physician Assistant Sound Inpatient Physicians Holdings, LLCEmergency Medicine Physician AssistantRadcliff, KYli/>How telemedicine can transform sepsis care in long-term facilities Discover how telemedicine is transforming sepsis care in long-term facilities-delivering faster intervention, better outcomes, and peace of mind for patients and providers. Specialty Leadership : Advance to senior leadership as Chief Advanced Practice Officer, where you will collaborate with service line leaders to influence organizational programs and lead initiatives that develop team-based care models on a national scale.
CMT Part Time 6pm-6am Louisville East Post AcuteCMT Part Time 6pm-6amLouisville, KYPart timeVerify that any medications brought into the facility by a newly admitted resident are examined and identified by the attending physician or the facility pharmacy or pharmacist • Follow facility policies and procedures regarding the destroying of medications; assist in carrying out these rules under the direction of the facility pharmacist or Director of Nursing Services, including the documentation requirements. The primary purpose of your job position is to assist in the administering of medications to residents as ordered by the attending physician, under the direction of the attending physician, the nurse supervisor or charge nurse, and the Director of Nursing Services.
Medication Aide Valhalla Post AcuteMedication AideLouisville, KYFull timeVerify that any medications brought into the facility by a newly admitted resident are examined and identified by the attending physician or the facility pharmacy or pharmacist • Follow facility policies and procedures regarding the destroying of medications; assist in carrying out these rules under the direction of the facility pharmacist or Director of Nursing Services, including the documentation requirements. General Purpose The primary purpose of your job position is to assist in the administering of medications to residents as ordered by the attending physician, under the direction of the attending physician, the nurse supervisor or charge nurse, and the Director of Nursing Services.
Veterinary Sonographer - Louisville, KY Veterinary Emergency GroupVeterinary Sonographer - Louisville, KYLouisville, KYThis means transforming how ER works, from our open-concept hospitals, where you can handle emergency cases of every kind (even exotics! to our immersive, customer-focused experience, which helps us give people and their pets the care they deserve. You'll also assist in coordinating education opportunities and overall ultrasound training for your home and regional hospitals, inspire and motivate your fellow VEGgies to grow their ultrasound skills, and be ready to pitch in at the hospital whenever and wherever needed.
Veterinary Sonographer - Louisville, KY Veterinary Emergency Group (VEG)Veterinary Sonographer - Louisville, KYLouisville, KYThis means transforming how ER works, from our open-concept hospitals, where you can handle emergency cases of every kind (even exotics!) to our immersive, customer-focused experience, which helps us give people and their pets the care they deserve. You'll also assist in coordinating education opportunities and overall ultrasound training for your home and regional hospitals, inspire and motivate your fellow VEGgies to grow their ultrasound skills, and be ready to pitch in at the hospital whenever and wherever needed.
Department Coordinator II University of LouisvilleDepartment Coordinator IIKYProcesses request for reimbursement, coordinates all conference and research-related travel plans and handles processing of travel reimbursement documentation to main accounting office for divisional personnel, including supervisor and other research personnel. Telephone Etiquette: Maintains a professional and courteous demeanor when handling phone communications, ensuring clear, respectful, and efficient interactions with patients, staff, and external contacts.
Med Mgmt Nurse Elevance Health IncMed Mgmt NurseLouisville, KYp>How you will make an impact: Utilizes nursing judgment and reasoning to analyze members' clinical information, interface with healthcare providers, make assessments based on clinical presentation, and apply clinical guidelines and/or policies to evaluate medical necessity. The Medical Management Nurse is responsible for review of the most complex or challenging cases that require nursing judgment, critical thinking, and holistic assessment of member's clinical presentation to determine whether to approve requested service(s) as medically necessary.