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Full Job Title BH Medical Director Job Number 1704524 Location Louisville , KY Date Posted 10 17 2017 The position is responsible for providing the clinical leadership for behavioral health in the assigned market. The position will help provide direction and management of behavioral health staff located in assigned markets which may include Behvaioral Health Concurrent Review, case man
Posted 5 days ago
Full Job Title Provider Operations Coordinator Job Number 1704162 Location Louisville , KY Date Posted 10 3 2017 Supports the Provider Relations Field Representative to achieve department goals. Answer incoming telephone inquiries from providers and assist with problem resolution of issues. Coordinate submission of provider to internal departments via contract maintenance forms. REPORT
Posted 19 days ago
Nurse will be based out of home, with travel required daily to assigned hospitals and facilities; Frequent travel required to regional health plan office. Valid driver's license, without restrictions, is required. Candidate Education Required A High School or GED Preferred A Bachelor's Degree in a related field Health Services or Nursing Candidate Experience Required 3 years of experience in a cli
Posted 19 days ago
Full Job Title Provider Relations Representative Job Number 1704309 Location Louisville , KY Date Posted 9 29 2017 Manages physician network by developing and maintaining relationships to drive business results within a specific geographic area. Provides service and education to network physicians/providers. Achieves company targets through implementation of Network Improvement plans.
Posted 24 days ago
Full Job Title Business Analyst, Sr Job Number 1704297 Location Louisville , KY Date Posted 9 22 2017 Leads in the development of complex adhoc reports to enable process and trend analysis. Provides recommendations on the implementation of new/revised operational and/or reporting processes. Conducts special projects requiring a high degree of confidentiality and expert knowledge of mul
Posted 1 month ago
Completes Licensed Health Care Risk Management certification program. Performs annual update on Plan Risk Management Program Description. Coordinates the regular and systematic review of all potential adverse incidents in accordance with state statute. Completes AHCA Code 15 Reports for confirmed adverse incidents. Submits an annual AHCA adverse incident summary report. Presents summary reports of
Posted 2 months ago
Full Job Title Quality Improvement Project Manager Job Number 1704022 Location Louisville , KY Date Posted 8 30 2017 Supports the development and implementation of quality improvement interventions and audits and assists in resolving deficiencies that impact plan compliance to regulatory and accreditation standards. Drives key quality improvement projects requiring the ability to work
Posted 2 months ago
Candidate Education Required A High School or GED Preferred A Bachelor's Degree in a related field Bachelor's degree may be substituted for 2 years of required experience Candidate Experience Required 2 years of experience in researching and resolving operational issues. Preferred Other experience in a healthcare environment with technical proficiency in Claims, Configuration or Operations with ex
Posted 2 months ago
Candidate Education Required A Bachelor's Degree in Business, Healthcare or related field Preferred A Master's Degree in a related field Candidate Experience Required 10 years of experience in healthcare sector (preferably at HMO or PPO) Required 7 years of experience in HMO provider/hospital/ancillary contracting and network development Required 5 years of management experience Candidate Skills A
Posted 2 months ago
Full Job Title Clinical Social Worker Job Number 1703850 Location Louisville , KY Date Posted 8 24 2017 "PLEASE NOTE THIS POSITION WILL COVER THE FOLLOWING COUNTIES JEFFERSON, BULLITT, OLDHAM, BRECKENRIDGE, SHELBY, GRAYSON, LARUE HENRY, MARION, MEADE, NELSON, TRIMBLE & WASHINGTON" Coordinates the socio economic needs and service of selected member populations across the continuum of il
Posted 2 months ago
Candidate Education Required A Bachelor's Degree in a related field or equivalent combination of education and experience required Candidate Experience Required 5 years of experience in Investigations and healthcare fraud related investigations combined Medical investigative experience with a focus on Medicaid and Medicare Preferred. Candidate Skills Advanced Knowledge of community, state and fede
Posted 2 months ago
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