Nurse

• Conduct comprehensive face-to-face assessments of newly admitted members at assigned acute care facilities
• Evaluate members’ physical, psychosocial, and health needs and refer them to Humana programs as appropriate
• Support and educate members and families on discharge planning from admission through post-discharge
• Facilitate follow-up visits with primary care providers
• Identify gaps in care, safety concerns, and barriers to discharge
• Develop and implement strategies to address care and discharge issues
• Collaborate with attending providers, facility case managers, and healthcare professionals
• Provide education on diagnoses, medications, and preventive measures
• Complete required documentation accurately and promptly
• Maintain infection control, safety, and patient privacy standards
• Coordinate care onsite at UK King's Daughters Medical Center and remotely document as permitted

Onsite Care Coordination Nurse improving hospital-to-home transitions for Humana members

Care Coordination Nurse

Onsite Care Coordination Nurse supporting Humana members at a Kentucky acute-care facility. Coordinating discharge planning and hospital-to-home transitions through hybrid clinical work.

• Review and make medical determinations as to whether pre-claim reviews and/or claims meet the member’s benefits
• Assess the necessity and reasonableness of items supplied in valid claims
• Use medical policy and other materials to make determinations
• Clearly articulate health information based on medical policy and criteria
• Complete required in-person training and onboarding activities
• Follow Government Business Division policies, procedures, guidelines, training, monitoring, and sensitive-data handling requirements when applicable

Clinical review nurse assessing claims for Elevance Health’s federal healthcare programs

Clinical Review Nurse I

Clinical review nurse assessing medical necessity and benefits coverage for Wellpoint Federal claims. Supporting Elevance Health’s federal healthcare programs through policy-based determinations.

• Review and make complex medical determinations about whether claims meet the member’s benefits
• Assess the necessity and reasonableness of items supplied in valid claims using medical policy
• Comprehend medical policy and criteria and clearly articulate health information
• Support federal programs through claims administration, data, and care delivery solutions
• Follow Government Business Division policies, procedures, guidelines, training, monitoring, and sensitive data handling requirements where applicable

Clinical Review Nurse II reviewing medical claims for Elevance Health’s federal healthcare programs

Clinical Review Nurse II

Clinical Review Nurse II making complex medical-necessity determinations for Elevance Health’s federal healthcare programs. Reviewing claims against member benefits and medical policy.

• Support day-to-day operations related to clinical charge audit and charge capture
• Support implementation and maintenance of standardized workflows developed with the Director of Charge Capture, Special Projects Manager, and Associate Vice President of Revenue Integrity
• Perform second-level charge audit reviews as requested by staff, payors, Patient Financial Services, Health Information Management, or the Director
• Use payor and coding guidelines to develop response plans for complex cases, including new technologies
• Conduct extensive research
• Communicate audit findings in written or verbal formats to respective departments or payors
• Apply department best practices to audit effectively while promoting continuous quality improvement
• Stay current on applicable payor and coding guidelines, industry trends, and best practices

Lead charge capture nurse auditing clinical revenue cycles for Baptist Health

Lead Charge Capture Nurse

Lead Charge Capture Nurse supporting Baptist Health’s clinical revenue integrity operations. Auditing charges, researching complex cases, and coordinating payor responses remotely in Kentucky or Indiana.

• Administer and dispense medication and injections according to accepted nursing practice guidance
• Manage patient medication preselection and drug administration
• Perform initial inductions and provide medical services as needed
• Conduct assessments and monitor vital signs for dose changes
• Educate patients regarding treatment, health, and safety policies
• Schedule appointments and document no-shows in the system
• Attend required on-site staff and multidisciplinary team meetings
• Sign and process physician orders; enter notes and flags in the EMR
• Maintain, monitor, and reconcile medication inventory
• Follow HIPAA and other regulatory and company compliance requirements
• Complete documentation using the designated EMR

LPN delivering medication-assisted behavioral healthcare at BrightView Health

Addiction Nurse, LPN

LPN administering medications and supporting recovery patients at BrightView Health, a behavioral healthcare provider.
Monitoring treatment, documenting care, and coordinating multidisciplinary services in Glasgow, Kentucky.

• Function as a Patient Care Assistant (PCA) in the float pool at your facility.
• Gain experience in a realistic professional nursing work environment by assisting in the delivery of both direct and indirect nursing care under the direction and supervision of a registered nurse.
• Work 24 hours/week, directly precepted by a RN, caring for patients on your unit of placement (24 hours of summer vacation allowed)

Nurse Extern supporting nursing students transition to RN role

Nurse Extern Program

Nurse Extern supporting nursing students' transition from student to RN in a hands-on environment. Working alongside professional nurses and gaining experience in a variety of clinical settings.

• Track and respond to calls for a multi-state nurse triage telephone service.
• Provide clinical assessment based on established protocols and triage patients by phone or through patient portal.
• Provide administrative support and perform clinical tasks.
• Facilitate referrals and collaborate on addressing prior authorization requests.
• Participate in Remote Patient Monitoring (RPM) initiatives.
• Screen and qualify patients for clinical trials.

Registered Nurse providing remote telephone triage support for various states

RN Telephone Triage Nurse – Compact License, IL, MA, NY, MN, DC

Registered Nurse providing remote telephone triage support. Handling clinical assessments and administrative tasks for multi-state telehealth services.

Nurse jobs in Kentucky

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