Top 37 Utilization management nurse Jobs in Louisville Ky

System Director, Authorization Management & Pre-Service
Norton Healthcare —Louisville, KY
- Full-time
- Background check
- 5 years
- Pass drug screening
- Paid parental leave
- Paid holidays
7d
RN Utilization Review
UofL Health —Louisville, KY
- Full-time
- Microsoft Word
- Nursing
- Microsoft Excel
4d
RN Utilization Review, Peace Hospital
UofL Health —Louisville, KY
- Full-time
- Nursing
- RN License
- Bachelor of Science
APP Clinical Manager
LiveWell Choice, LLC —Louisville, KY
- Full-time
- Nursing
- Clean driving record
- Microsoft Excel
- Paid time off
Quick Apply
Dialysis Clinical Manager Registered Nurse - RN
Fresenius Medical Care —La Grange, KY
- Full-time
- Nursing
- Heavy lifting
- RN License
- Tuition reimbursement
Quick Apply
Manger Utilization Management & Quality, Peace Hosptial
UofL Health —Louisville, KY
- Full-time
- Nursing
- RN License
- Licensed Clinical Social Worker
8d
Registered Nurse
Optum —Louisville, KY
- $64,100 - $141,500 a year
- Full-time
- CPR Certification
- RN License
- Writing skills
Quick Apply
Manager, Care Management
Norton Healthcare —Louisville, KY
- Full-time
- Nursing
- RN License
- Mid-level
4d
Case Manager II PRN
Kindred Hospital Louisville —Louisville, KY
- PRN
- Master of Social Work
- Nursing
- RN License
8d
Nurse Manager, UofL Hospital, OR
UofL Health —Louisville, KY
- Full-time
- Nursing
- RN License
- Bachelor of Science
Case Manager II
Kindred Hospital Louisville at Jewish Hospital —Louisville, KY
- Master of Social Work
- Nursing
- RN License
8d
Health Plan Care Manager (RN or LSW)
CommuniCare Advantage —Clarksville, IN
- Full-time
- Nursing
- RN License
- Mid-level
Quick Apply
Outpatient Wound Care Clinic RN, Part-time Days
Kindred Hospital Louisville —Louisville, KY
- Part-time
- Nursing
- RN License
- Mid-level
Nurse Manager, Mary and Elizabeth Hospital, Endoscopy
UofL Health —Louisville, KY
- Full-time
- Nursing
- RN License
- Bachelor of Science
Weekend Registered Nurse
Optum —New Albany, IN
- $71,677 - $107,516 a year
- Full-time
- CPR Certification
- RN License
- Writing skills
Quick Apply
RN Supervisor, Care Management, Frazier Rehab Institute
UofL Health —Louisville, KY
- Full-time
- Microsoft Word
- CPR Certification
- Nursing
9d
RN, Mary and Elizabeth Hospital, Cath Lab, PRN
UofL Health —Louisville, KY
- Part-time
- Microsoft Word
- Nursing
- RN License
Provider Lead
Crossover Health —Louisville, KY
- Part-time
- Certified Nurse Practitioner
- BLS Certification
- Internal Medicine
7d
Nurse Manager, UofL Hospital, 9E Neuro Trauma PCU
UofL Health —Louisville, KY
- Full-time
- Nursing
- RN License
- Bachelor of Science
Nurse Practitioner
Chen Medical Associates —Louisville, KY
- $107,903 - $154,147 a year
- Nursing
- Skilled nursing facility
- Surgery
- Opportunities for advancement

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utilization management nurse jobs near louisville ky

System Director, Authorization Management & Pre-Service

Norton Healthcare -
Louisville, KY

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Job Details

Full-time
7 days ago

Benefits

Paid parental leave
Paid holidays
Health insurance
Dental insurance
401(k)
Parental leave
Vision insurance
403(b)

Qualifications

Bachelor's degree
Senior leadership

Full Job Description

Location: Louisville, Kentucky
Job Category: Executive Leadership
Job ID: 159791
Facility Group: Norton System Services

Job Description

Responsibilities

The System Director Authorization Management & Pre-Service leads and manages a team composed primarily of denial nurses, utilization review nurses (RN, LPN), pre-service and insurance verification representatives. This team develops processes for prospective, concurrent and retrospective utilization review. They provide timely notification of admission to third party payors and managed care companies. The team works closely with the hospital-based care managers and clinical offices to provide clinically accurate, timely and meaningful clinical reviews to payors in order to obtain authorizations. The System Director Authorization Management & Pre-Service collaborates with staff external to the organization (payors), as well as members of the Norton Healthcare team (Patient Financial Services, Registration, Norton Medical Group, Health Information Management, and Care Management). As a key leader in Norton Healthcare's Improvement Network, the System Director Authorization Management & Pre-Service, will coach and facilitate this team in performance improvement initiatives, to ensure high quality outcomes and exceptional patient care. Tracking, trending and reporting key financials (lost revenue due to denials) is required. The System Director Authorization Management & Pre-Service provides guidance to staff on preventing and appealing denials and educates on medical necessity criteria such as InterQual and/or Milliman Care Guidelines. This position also leads and develops processes for securing outpatient authorizations. The team works closely with clinic offices and provides and obtains accurate, timely authorizations from payors.

Key Accountabilities:

Assists staff to ensure proper hospital &payor authorization requirements are met. Maintains current organized databases regarding payor requirements, reviews, contacts, decisions and appeals. Is knowledgeable of managed care contracts, government payment methodologies and coverage guidelines.
Provides annual performance evaluations for direct reports & provides feedback to other system leaders as requested. Evaluates annual employee engagement results and works with teams to establish action plans to ensure workforce concerns are being addressed. Mentors & coaches team as needed to ensure that members have the right tools and training to deliver on expected goals and quality patient care.
Identifies and coordinates improvement opportunities and leads formal groups to identify processes to reduce insurance denials/loss of revenue. Continually assesses the insurance authorization process for opportunities to streamline and eliminates duplication of work. Collaborates with staff & leaders in other departments (both external and internal to NHC). Provides appropriate feedback to the staff as needed regarding payor guideline changes.
Responsible for achieving annual department performance metrics developed by system leadership, and the management of financial resources to meet and exceed the expected budget (efficient utilization review).
Demonstrates critical thinking, problem solving and prioritization skills. Uses positive communication techniques, is skilled in empathizing, listening and supporting while maintaining strict professional boundaries. Manages the department by leading as a role model. The leader holds themselves accountable to the same performance expectations as those reporting to them.

Qualifications

Required:

Five (5) years of management experience in care management & care coordination setting and/or clinical experience.
Bachelor Degree

Desired:

Master Degree
Certified Case Manager OR Certified Professional in Denial & Appeal Management

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Screening requirements:

Background check
License & education verification
Employment reference verification
Drug Screen

Norton Healthcare offers a competitive benefit package, including:

Paid vacation, sick days and holidays
Paid parental leave
403b/401k retirement plan
View more: Benefits Guide
Medical, Dental, and Vision Insurance

Discover meaningful career opportunities at NortonHealthcareCareers.com.
Norton Healthcare Careers - Together, We Will.

Norton Healthcare is a leader in serving adult and pediatric patients from throughout Greater Louisville, Southern Indiana, the commonwealth of Kentucky and beyond. The not-for-profit hospital and health care system is Louisville's second largest employer, with more than 20,000 employees.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

Norton Healthcare strives to make the Norton Healthcare Careers site accessible to all job seekers. If you're a candidate with a disability, we will make reasonable efforts to accommodate your needs during the application process.

If you have a disability and need to request a reasonable accommodation, email [email protected]

Equal Employment Opportunity is the law.

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Refine Your Search

utilization management nurse jobs in louisville ky

System Director, Authorization Management & Pre-Service

RN Utilization Review

RN Utilization Review, Peace Hospital

APP Clinical Manager

Dialysis Clinical Manager Registered Nurse - RN

Manger Utilization Management & Quality, Peace Hosptial

Registered Nurse

Manager, Care Management

Case Manager II PRN

Nurse Manager, UofL Hospital, OR

Case Manager II

Health Plan Care Manager (RN or LSW)

Outpatient Wound Care Clinic RN, Part-time Days

Nurse Manager, Mary and Elizabeth Hospital, Endoscopy

Weekend Registered Nurse

RN Supervisor, Care Management, Frazier Rehab Institute

RN, Mary and Elizabeth Hospital, Cath Lab, PRN

Provider Lead

Nurse Manager, UofL Hospital, 9E Neuro Trauma PCU

Nurse Practitioner

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