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DescriptionSt. Francis is NOW HIRING a Per Diem RN- Case Manager to join the Case Management/Discharge Planning Team!This is a PRN position to cover weekend shifts across the hospital. Looking for some extra money, this is the position for you!POSITION SUMMARY:&nbsp;The goal of hospital Case Management is resource coordination along a continuum to help patients to achieve optimal health, access to care and appropriate utilization of resources. Case managers work collaboratively with patients, nurses, physicians and other practitioners, caregivers and community resources and agencies to provide cost effective care that reflects a patient’s preferences and values. Healthcare is a right, and patients have choices. Our services should reflect that concept. Responsibilities of the floor case manager are as follows: PRIMARY (ESSENTIAL) DUTIES:&nbsp;<ul><li>Manage census for DC planning for the floor you are assigned</li><li>Review every status order and ensure accuracy. Handle inappropriate status orders per protocol</li><li>Review all observation cases minimally twice daily</li><li>Review all new admissions and provide UR to insurance companies per regulations</li><li>Perform and submit continued stay reviews daily</li><li>Perform continued stay reviews every 48 hours for payor not requiring submission</li><li>Organize and plan discharges for the day</li><li>Daily rounding with treatment team</li><li>Perform high risk assessment on all patients when admitted</li><li>Perform discharge screen/assessment on day one. Reassess every 48 hours</li><li>Have patients sign choice letters, when needs are identified</li><li>Make post-acute care referrals as need is identified</li><li>Issue Important Message from Medicare letters initially if needed, and within 48hours prior to discharge</li><li>Issue MOON to observation patients</li><li>Issue HINNs as needed</li><li>Complete Code 44’s as necessary</li><li>Identify and review 30 day readmits. Collaborate with treatment team to prevent further readmissions</li><li>Understand DRG/GMLOS to appropriately discharge plan in collaboration with physicians</li><li>Avoidable days management</li><li>Responsible for knowing and practicing the Utilization Management Plan</li></ul>The above statements reflect the general duties considered necessary to describe the principal functions of the job as identified and shall not be considered as a detailed description of all the work requirements that may be inherent in the position.&nbsp;ORGANIZATIONAL RELATIONSHIPS <ul><li>A direct reporting relationship is established to the Case Management department director. Interacts with medical center personnel, patients, and providers on a daily basis</li></ul> QualificationsEducation:&nbsp;<ul><li>completion of an accredited schooling for LPN, ADN or BSN, required</li></ul>Licenses/Certification:&nbsp;<ul><li>Active Georgia State RN or LPN License OR Compact License</li></ul>Experience:&nbsp;<ul><li>3+ years’ experience in discharge planning, case management or acute care nursing is also preferred</li><li>Case management certifications preferred.</li></ul>

St. Francis-Emory Healthcare

RN Case Manager - Per Diem

DescriptionAt ScionHealth, we empower our caregivers to do what they do best. We value every voice by caring deeply for every patient and each other. We show courage by running toward the challenge and we lean into new ideas by embracing curiosity and question asking. Together, we create our culture by living our values in our day-to-day interactions with our patients and teammates.Job Summary<ul><li>The Registered Nurse (RN) - ICU provides comprehensive nursing care to critically ill patients in the Intensive Care Unit. The RN monitors hemodynamic status, administers medications, performs assessments, and collaborates with the interdisciplinary care team. The RN ensures optimal patient outcomes through adherence to clinical protocols, safety guidelines, and effective communication with patients and families.</li></ul>Essential Functions<ul><li>Provides direct and indirect patient care in a critical care setting, including hemodynamic monitoring and management of critically ill patients</li><li>Administers medications, monitors for side effects, and responds to adverse events</li><li>Performs comprehensive assessments, including head-to-toe assessments, pain assessments, and reassessments</li><li>Develops and implements individualized care plans based on patient condition and response to treatment</li><li>Collaborates with physicians, respiratory therapists, and other healthcare providers to optimize patient care</li><li>Educates patients and families on treatment plans, medication regimens, and discharge instructions</li><li>Participates in emergency response and crisis management, including code blue and rapid response situations</li><li>Assists in invasive procedures, including central line insertions and arterial line placements</li><li>Adheres to infection control protocols and maintains a safe environment for patients and staff</li><li>Documents patient care activities, assessments, and interventions accurately and timely in the electronic medical record (EMR)</li></ul>Knowledge/Skills/Abilities/Expectations<ul><li>Advanced clinical knowledge in critical care nursing and emergency response</li><li>Strong communication and interpersonal skills</li><li>Ability to prioritize tasks and manage multiple responsibilities effectively</li><li>Proficiency in electronic medical records (EMR) and medical equipment operation</li><li>Demonstrates professionalism, integrity, and a commitment to patient-centered care</li><li>Ability to lift up to 50 lbs and perform extended periods of standing, walking, and physical activity</li></ul> QualificationsEducation<ul><li>Associate Degree in Nursing (ADN) required</li><li>Bachelor of Science in Nursing (BSN) preferred</li></ul>License/Certification<ul><li>Current RN license in the state of practice or compact state required</li><li>Basic Life Support (BLS) Certification within timeframe specified by facility policy</li><li>Advanced Cardiovascular Life Support (ACLS) Certification within timeframe specified by facility policy</li><li>Pediatric Advanced Life Support (PALS) Certification preferred</li><li>De-escalation Training required</li></ul>Experience<ul><li>Minimum of six (6) months of experience in an acute care setting preferred</li></ul>

CVICU RN Full Time Nights

Job Title APP Nurse Anesthetist/UKHC Requisition Number RE51202 Working Title CRNA Department Name MG300: Anesthesiology Work Location Lexington, KY Grade Level 18 Salary Range $75.03-141.76/hour Type of Position Staff Position Time Status Full-Time Required Education BS Click here for more information about equivalencies: <a href="https://hr.uky.edu/employment/working-uk/equivalencies" target="_blank">https://hr.uky.edu/employment/working-uk/equivalencies</a> Required Related Experience 0 yrs Required License/Registration/Certification Certified Registered Nurse Anesthetist (CRNA) Physical Requirements Lifting, pushing, or pulling objects up to 50 lbs. Shift Monday through Friday, 36 – 40 hours per week, (8s, 10s, 12s) with optional overtime. Job Summary UK Healthcare is seeking a Certified Registered Nurse Anesthetist (CRNA) for a growing academic medical center – the ideal place to reach the peak of your CRNA profession. New and experienced CRNAs are welcome! UK Healthcare, with complex cases and high levels of acuity, offers an outstanding work-life balance, competitive pay, and autonomous CRNA practice. CRNAs manage patients of all ages, place invasive lines, and cover most case types including trauma. The selected candidate will care for patients at all acuity levels across the lifespan in a variety of settings for a large case mix. CRNAs can work to their full scope of practice and enhance their skill set with frequent educational opportunities. We offer up to $4,000 towards professional development funds as well as 2 CME paid weeks off each year. Our work-life friendly schedule is Monday -Friday, 36-40 hours per week, (8s, 10s, or 12s) with optional overtime. Any overtime is compensated at 1.5 times the hourly rate, with additional compensation for weekends, evenings, etc. No call. Starting minimum yearly income of $254,987. Sign-on bonuses are offered! Interested applicants are welcome to contact us with any questions or to discuss the opportunity further. Please contact Chief CRNAs Greg Buckler (<a href="mailto:greg.buckler@uky.edu" target="_blank">greg.buckler@uky.edu</a>), or Mark Anderson (<a href="mailto:marshall.anderson@uky.edu" target="_blank">marshall.anderson@uky.edu</a>). Skills / Knowledge / Abilities The CRNA will demonstrate an advanced level of medical and nursing knowledge, clinical and technical competency, sound clinical judgment, and professionalism as it relates to interpersonal and general communication skills. In addition, the qualified candidate will provide timely and compliant documentation, take responsibility for ongoing professional development and competency validation, and demonstrate strong communication, attention to detail, and critical thinking skills. The CRNA contributes to excellence in patient care, research, teaching, consulting, and provides leadership to the organization. Does this position have supervisory responsibilities? No Preferred Education/Experience Deadline to Apply 08/28/2025 Our University Community We value the well-being of each of our employees and are dedicated to creating a healthy place for everyone to work, learn and live. In the interest of maintaining a safe and healthy environment for our students, employees, patients and visitors the University of Kentucky is a Tobacco &amp; Drug Free campus. As an Equal Opportunity Employer, we strongly encourage veterans, individuals with disabilities, women, and all minorities to consider our employment opportunities. Any candidate offered a position may be required to pass pre-employment screenings as mandated by University of Kentucky Human Resources. These screenings may include a national background check and/or drug screen.

APP Nurse Anesthetist/UKHC

Job Title Nurse Clinical / UKHC Requisition Number NR14080 Working Title Nurse Clinical / ED Department Name H3100:Emergency Services Work Location Lexington, KY Grade Level 10 Salary Range $23.25-39.10/hour Type of Position Staff Position Time Status Full-Time Required Education BSN Required Related Experience 2 yrs Required License/Registration/Certification Registered Nurse (RN) Physical Requirements Standing and lifting Shift Must be able to work a variety of shifts (Days, Eves, Nights, Swing). Will work 36 hours / week and will be required to work some weekends and holidays as needed per schedule and unit coverage. Job Summary The primary responsibilities for this position consist of providing total, comprehensive, continuous and patient centered care which includes: assessing, documenting, planning, implementing, teaching, developing, and evaluating a comprehensive nursing plan of care; delivering direct patient care; ensuring patient satisfaction; training and delegating duties for Nursing Care Technicians (Nursing Assistant); and adhering to University policies and procedures as well as federal, state and local regulations. Furthermore, this environment supports collaborative efforts among the nursing staff and the team of physicians to increase communication and enhance expected patient outcomes. This includes utilization of the nursing process in conjunction with a comprehensive patient-centered plan of care, ensuring patient satisfaction. Skills / Knowledge / Abilities Customer Service, Computer Skills, nursing processes / policies Does this position have supervisory responsibilities? No Preferred Education/Experience ED experience with ACLS, PALS, TNCC, ENPC preferred. Deadline to Apply 08/31/2025 Our University Community We value the well-being of each of our employees and are dedicated to creating a healthy place for everyone to work, learn and live. In the interest of maintaining a safe and healthy environment for our students, employees, patients and visitors the University of Kentucky is a Tobacco &amp; Drug Free campus. As an Equal Opportunity Employer, we strongly encourage veterans, individuals with disabilities, women, and all minorities to consider our employment opportunities. Any candidate offered a position may be required to pass pre-employment screenings as mandated by University of Kentucky Human Resources. These screenings may include a national background check and/or drug screen.

Nurse Clinical / UKHC

SUMMARYThe Acute Registered Nurse provides acute dialysis care and treatment to patients within a hospital environment. This position performs duties as assigned by the Charge Nurse or Acute Manager, including assisting and supervising Patient Care Technicians and Licensed Vocational Nurses. Acute nurses may report directly to an Acute Manager, Administrator or the first line of regional operational management which may be an Area Director, Regional Director, or Vice President of Operations, depending on the region/demographics.Essential Duties and Responsibilities include the following. Other duties and tasks may be assigned.GROWTH· Assist with clinical and operational processes to improve patient health and minimize hospitalizations and rehospitalization.· Ensure patient and treatment charge information and other related data are accurate and submitted appropriately. · Demonstrate effective use of supplies and staff labor hours.· May participate in inventory management, including end-of-month inventory reporting and adherence to company purchasing protocols.· Perform duties as assigned to meet the patient care or operational needs.OUTCOMES· Administer medications as ordered by the physician..· Provide patient education and follow up as needed.· Assist with program's target goals in meeting quality metrics for patient outcomes in accordance with quality patient care and Company goals.OPERATIONALREADINESS· Knowledge of and comply with federal, state, local laws and regulations, including health care professionals practice act requirements.· Perform duties at all times within limitations established by and in accordance with company policy and procedures, hospital policy, applicable state and federal laws and regulations.· Complete water quality verification and equipment safety checks prior to each treatment, to include second verification as required.· Complete pre and post treatment physical assessments.· Complete pre and post Handoff Communication with hospital nurses.· Initiate and terminate patient treatments to include connecting and disconnecting catheters and cleaning catheter sites.· Set up dialysis machines; report machine problems to biomedical technician and/or Acute Manager as appropriate.· Clean, disinfect and provide quality control of dialysis machines as required by policy and procedures.· Participate in infection control monitoring, implementation, and recording as requested.· Use personal protective equipment as necessary.· Be familiar with emergency equipment and all emergency operational procedures, as required by hospital.OPERATIONALREADINESS (cont.)· Demonstrate effective staffing based on acuity, skill mix and company guidelines.· Ensure provision of dialysis related services such as Hemodialysis, Peritoneal dialysis, Continuous Renal Replacement Therapy (CRRT) and Plasmapheresis (TPE) if contracted to do so.· Participate in all surveys as required.· Ensure nursing care is carried out as directed and treatment is administered in accordance with physician orders.· Ensure appropriate and required information is documented in patient records.· Inform Supervisor, Medical Director or Physician and Hospital Liaison of all incidents, conditions, and concerns related to patient care, staff and patient safety, and in accordance with company policy.· Prepare and maintain dialysis machines and systems per policy: maintain dialysis records, prepare dialysis water treatment system for use according to established procedure and understand technical operations to troubleshoot problems independently.· Notify Bio-Medical Technician regarding machine or water treatment malfunctions, values out of parameters and document as required. PARTNERSHIPS· Communicate results of patient assessment, reassessment, and ongoing monitoring to the physician.· Maintain collaborative working relationship with physicians, nurse practitioners, and other hospital healthcare professionals.· Actively promote GUEST customer service standards; develop effective relationships at all levels of the organization.· Address patient concerns timely and professionally; following hospital policy.STAFF DEVELOPMENT/ RETENTION· Participate in staff meetings as required. Attend and complete all company and hospital required in-service and continuing education.· May delegate tasks to competent licensed and unlicensed staff per applicable state practice act.· Assist with staff training as requested.· Lead staff in team concepts and promote a team effort.

U.S. Renal Care

Dialysis Registered Nurse - Acute

USRC's greatest strength in being a leader in the dialysis industry is our ability to recognize and celebrate the differences in our diverse workforce. We strongly believe in recruiting top talent and creating a diverse and inclusive work climate and culture at all levels of our organization.The Home Therapy Registered Nurse, as qualified by federal and state regulations, provides patient training and ongoing support for all patients choosing a home dialysis modality.&nbsp; This position is accountable for providing quality care to all patients and is committed to delivering superior customer service in all internal and external interactions.&nbsp;&nbsp; ESSENTIAL DUTIES AND RESPONSIBILITIES include the following.&nbsp; Other duties and tasks may be assigned.<ul><li>Knowledge of and comply with federal, state, local laws and regulations, including health care professionals practice act requirements as they pertain to home dialysis program and patient care requirements.</li><li>Train patient (and/or care partner) in the practice of self-care Peritoneal Dialysis or Hemodialysis upon meeting federal and state regulations governing Registered Nurse qualifications.</li><li>Conduct home visits to assess the patient's home environment per policy; initially and minimally annually thereafter.&nbsp; Routinely evaluate patient performance and assess the home environment more frequently as needed to improve care.</li><li>Communicate results of patient assessment, reassessment, and ongoing monitoring to the physician, team members, and others as appropriate to the individual needs of the patient.</li><li>Document all nursing services in the Electronic Medical Record including but not limited to training sessions, routine and non-routine in-person interactions, and phone conversations.&nbsp; Documentation should accurately reflect the patient status and nursing interventions and be written to ensure continuity of care.</li><li>Participate in infection control monitoring, implementation, and recording as requested.</li><li>Be familiar with emergency equipment and all emergency operational procedures.&nbsp; Communicate and regularly review Emergency Preparedness procedures with all home patients, including but not limited to emergency disconnection from dialysis equipment, what to do and who to contact if displaced from home.</li><li>Ensure clinic and patient supply inventory and usage is appropriate for patient prescriptions and place orders in timely manner to avoid fees and penalties.</li><li>Continually seek to improve patient and quality outcomes through tracking and trending of program and patient performance, use of critical thinking skills and root cause analysis to improve patient and quality outcomes.&nbsp; Assist in obtaining data for the continuous quality improvement activities.</li><li>Obtain routine and non-routine laboratory tests as ordered and communicate critical lab values and urgent patient needs to the responsible physician or physician extender in a timely manner.</li><li>Complete and document monthly review of patient medication profiles.&nbsp; Administer medications as ordered by the physician.</li><li>Responsible for performing on call nursing services, nights and weekends, on a rotational basis as needed or assigned.</li><li>Flexible with staffing locations and hours to accommodate patient and USRC home program needs.</li><li>Regular and reliable attendance is required for the position.</li></ul>Home Hemodialysis Only:<ul><li>Coordinate home evaluation with technical services department to ensure that the necessary electrical, plumbing and drainage requirements for proper equipment operation are met prior to patient acceptance into home program.</li><li>Ensure required and appropriate water sampling is complete per policy and product requirements.&nbsp; Monitor and report water sample and culture results.&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;</li></ul>

Dialysis Registered Nurse, Home Hemo & Peritoneal RN

<h4>How you'll change lives</h4>As a Registered Nurse (RN) at US Renal Care, you'll be an integral part of a cross-functional team, working under the supervision of a Charge Nurse and assisting and supervising Patient Care Technicians (PCTs) to care for patients living with kidney disease.<h4>What you'll be doing</h4>Patient care. You'll work directly with patients to provide safe, comfortable, and high-quality dialysis treatment. Responsibilities include completing and documenting physical assessments before and after treatments and monitoring patients during treatment. You'll ensure quality renal care by completing monthly reviews of patient medication profiles and administering medications according to physician orders. Teamwork. You'll be a critical member of an interdisciplinary team to provide all required patient assessment and care planning activities. You'll also make sure center staffing requirements are met at all times under the direction of the Administrator and according to state regulations for staffing ratios.Safety &amp; Quality. Working under the supervision of a Charge Nurse, you'll adhere to all company policies and procedures and state and federal laws and regulations. You'll participate in all required staff meetings and continuing education offerings.

Dialysis Registered Nurse

Job Title Nurse Clinical/UKHC /Trauma 7100 UB / 7P WEPP /RN Requisition Number NR14148 Working Title RN/Trauma and Acute Care Surgical Services Pavilion A Tower 100 Universal Department Name H7000:Trauma and Acute Care Surgery Services Work Location Lexington, KY Grade Level 10 Salary Range $23.25-39.10/hour Type of Position Staff Position Time Status Full-Time Required Education ADN Required Related Experience No experience required. Required License/Registration/Certification Active Kentucky Registered Nurse (RN) license, Temporary Work Permit (TWP), Provisional License or active compact state Registered Nurse (RN) license that is in good standing and American Heart Association (AHA) Basic Life Support certification for the Healthcare Provider valid for at least 6 months after employment date Physical Requirements The essential functions for this position include the ability to lift, carry, push, and pull 50-100 pounds on a daily basis and 25-50 pounds frequently; as well as stand, walk and sit for long periods of time. The conditions of work may involve exposure to communicable diseases, hazards of radiation, and injury from intractable patients or sharp instruments. Shift Must be able to work TWO, 12 hour 7PM-730AM Night shifts 24 hours / week. This is a Weekend Premium Position (WEPP). Work 24 hours on 7P, / week, get paid for 36 hours / week. Job Summary Registered Nurses in the Trauma Acute Care Unit in Tower 100 of the Trauma Acute Care Surgical Center at UK Chandler Hospital provide care primarily for adult patients with acute trauma conditions. Patient conditions include injuries resulting from blunt and penetrating trauma, vascular, and non-elective orthopedic surgeries. The Trauma Acute Care Surgical Center is comprised of three units: ICU, Progressive Care, and Acute Care. The average length of stay for most patients is 5 days. This is primarily in the ACUTE care setting. The primary responsibilities for this position consist of providing total, comprehensive, continuous and patient centered care which includes: assessing, documenting, planning, implementing, teaching, developing, and evaluating a comprehensive nursing plan of care; delivering direct patient care; ensuring patient satisfaction; training and delegating duties for Nursing Care Technicians (Nursing Assistant); and adhering to University policies and procedures as well as federal, state and local regulations. Furthermore, this environment supports collaborative efforts among the nursing staff and the team of physicians to increase communication and enhance expected patient outcomes. This includes utilization of the nursing process in conjunction with a comprehensive patient-centered plan of care, ensuring patient satisfaction. Skills / Knowledge / Abilities The ideal candidate will have the following: knowledge of Maslow’s eight Basic Human Needs and the priority within Gordon’s Functional Health Patterns Frame Work as well as Swanson’s Caring model; superb direct patient care and critical thinking skills; basic computer navigation skills and working knowledge of the internet; ability to communicate in a professional and respectful manner with patients and their families, co-workers and physicians; and strong organizational, prioritization, and delegation skill. The candidate will be highly motivated, pro-active and confident in advocating for patients and their family members. Will also enjoy working in a strong team environment and provides open, honest communication with fellow staff and physicians. In addition, the ideal candidate will possess exceptional technical skills and a proven ability to work in a team as well as independently. Does this position have supervisory responsibilities? No Preferred Education/Experience BSN + AT LEAST 1 YEAR OF RN EXPERIENCE PREFERRED Deadline to Apply 08/31/2025 Our University Community We value the well-being of each of our employees and are dedicated to creating a healthy place for everyone to work, learn and live. In the interest of maintaining a safe and healthy environment for our students, employees, patients and visitors the University of Kentucky is a Tobacco &amp; Drug Free campus. As an Equal Opportunity Employer, we strongly encourage veterans, individuals with disabilities, women, and all minorities to consider our employment opportunities. Any candidate offered a position may be required to pass pre-employment screenings as mandated by University of Kentucky Human Resources. These screenings may include a national background check and/or drug screen.

Nurse Clinical/UKHC /Trauma 7100 UB / 7P WEPP /RN

The hiring range for this role is: &nbsp;$103,676.95 - $159,759.88This is the lowest to highest salary we, in good faith, believe we would pay for this role at the time of this posting.&nbsp; We may ultimately pay more or less than the hiring range andthis hiringrange may also be modified in the future. A candidate’s position within the hiring range may be based on several factors including, but not limited to, specific competencies, relevant education, qualifications, certifications, relevant experience, skills, seniority, performance, shift, travel requirements, and business or organizational needs.&nbsp;This job is also eligible for annual bonusincentivepay.We offer a comprehensive package of benefits including paid time off, 11 holidays, medical/dental/vision insurance, generous 401(k) matching, lifestyle spending account and many other benefits to eligible employees.Note: No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission, or any other form of compensation that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.Responsible for overseeing all Utilization Management (UM) and Medical Policy deliverables within the organization. This includes identification, implementation, oversight, management, and evaluation of UM and Medical Policy program functions and initiatives. Serves as a clinical and technical expert, provides technical guidance and education to internal and external business partners regarding UM and Medical Policy clinical criteria and industry standards. Conducts systematic analysis to evaluate evidence-based clinical guidelines to develop and update medical policies. Additionally, reviews and evaluates new benefits, participate in complex projects, and ensures medical policy documentation aligns with benefit design and contractual obligations, supporting program performance assessment and accreditation.<li>Act as a liaison, resource, and clinical subject matter expert to internal and external business partners. Provide guidance on utilization management and medical policy activities, ensuring the development and implementation of required strategies, programs, and products. Promote and reinforce Plans’ accountability for achieving business outcomes, while providing ongoing monitoring, evaluation, and revision of guidelines as needed 25%</li><li>Conduct systematic reviews of evidence-based reference policy documents and current clinical literature to develop and update medical policies. Ensure consistency with benefit design, contractual obligations, and program/accreditation requirements. Adhere to the medical policy review cycle schedule, lead content development for draft documents, and prepare and present medical policy content and review procedures to the Pharmacy and Medical Policy Committee for approval 25%</li><li>Manage critical escalations that have external visibility and impact member and provider satisfaction. Evaluate options and work with BCBS Plans for resolution. Identify and manage risks, resolve conflicts, and remove barriers that impede Plans’ ability to achieve goals and performance expectations 25%</li><li>Contribute to cross-functional teams by interpreting utilization data, medical coding, and policy research. Translate trend information into strategic action plans, resulting in value-added resources and programs that address business needs and support program strategic initiatives 15%</li><li>Lead background clinical research on current and emerging technology areas, including the FDA approval or clearance status of FDA-regulated products. Synthesize, summarize, and present information to internal and external business partners as the evidence basis for medical necessity and experimental/investigational determinations 10%</li> Job Overview: Responsible for overseeing all Utilization Management (UM) and Medical Policy deliverables within the organization. This includes identification, implementation, oversight, management, and evaluation of UM and Medical Policy program functions and initiatives. Serves as a clinical and technical expert, provides technical guidance and education to internal and external business partners regarding UM and Medical Policy clinical criteria and industry standards. Conducts systematic analysis to evaluate evidence-based clinical guidelines to develop and update medical policies. Additionally, reviews and evaluates new benefits, participate in complex projects, and ensures medical policy documentation aligns with benefit design and contractual obligations, supporting program performance assessment and accreditation. Essential Functions<ul><li>Act as a liaison, resource, and clinical subject matter expert to internal and external business partners. Provide guidance on utilization management and medical policy activities, ensuring the development and implementation of required strategies, programs, and products. Promote and reinforce Plans’ accountability for achieving business outcomes, while providing ongoing monitoring, evaluation, and revision of guidelines as needed</li><li>Conduct systematic reviews of evidence-based reference policy documents and current clinical literature to develop and update medical policies. Ensure consistency with benefit design, contractual obligations, and program/accreditation requirements. Adhere to the medical policy review cycle schedule, lead content development for draft documents, and prepare and present medical policy content and review procedures to the Pharmacy and Medical Policy Committee for approval</li><li>Manage critical escalations that have external visibility and impact member and provider satisfaction. Evaluate options and work with BCBS Plans for resolution. Identify and manage risks, resolve conflicts, and remove barriers that impede Plans’ ability to achieve goals and performance expectations</li><li>Contribute to cross-functional teams by interpreting utilization data, medical coding, and policy research. Translate trend information into strategic action plans, resulting in value-added resources and programs that address business needs and support program strategic initiatives</li><li>Lead background clinical research on current and emerging technology areas, including the FDA approval or clearance status of FDA-regulated products. Synthesize, summarize, and present information to internal and external business partners as the evidence basis for medical necessity and experimental/investigational determinations</li></ul>QualificationsEducation <ul><li>Required Bachelor's Degree in nursing or related field from an accredited university; or equivalent work experience</li><li>Preferred Master's Degree</li><li>Experience </li><li>5+ Years of experience with Utilization Management and Medical Policy development in a managed care setting Required</li><li>Knowledge Skills and Abilities </li><li>Excellent written and verbal communication skills Ability to translate complex, technical and/or quantitative information in clear, concise, and understandable documents of presentation Advanced project management skills for planning and executing multiple projects and a detail orientation to ensure compliance with accreditation standards and accuracy of statistics Demonstrated ability to identify and create strategies that support initiatives and translate these into strategic action plans Ability to work well in an interdisciplinary clinical team environment Demonstrated ability to foster strong working relationships with customers and business stakeholders and contact Demonstrated ability to handle multiple projects, prioritizing critical aspects/tasks, working under pressure and meeting deadlines Ability to lead independent research Technical proficiency with information technologies (e.g. Microsoft Office) and literature-search databases Demonstrated abilities in data analysis, synthesis, and reporting, including systematic analysis of clinical literature Ability to conduct comparative analysis of external medical policies, with detailed analysis of specific clinical indications Demonstrated ability to understand complex medical technology assessments and detailed analysis of specific clinical indications in medical policies</li><li>Certifications &amp; Licenses </li><li>Required: RN-CS - RN Certified Clinical Specialist -</li><li>Preferred: CPHM - Certified Professional in Healthcare Management - AIHM</li><li>Preferred: Certified Professional Coder (CPC) - AAPC</li><li>Preferred: Accredited Case Manager (ACM) - ACMA</li></ul> Extra Posting information: A minimum of four years of experience with Utilization Management and Medical Policy development in a managed care setting. Experience with URAC/NCQA accreditation requirements. Experience presenting information to large audiences (town hall calls, professional conferences, etc.), both virtually and in-person. Experience in leading cross-functional work Experience related business experience which demonstrates knowledge and understanding of PPO operations, business practices and processes, as well as knowledge of corporate goals.#LI-Hybrid

Blue Cross Blue Shield Association

Utilization Senior Program Manager (Registered Nurse)

Job Title Nurse Navigator/UKHC Requisition Number RE49438 Working Title Nurse Navigator Department Name H3000:Acute Care Work Location Lexington, KY Grade Level 11 Salary Range $54,080-95,056/year Type of Position Staff Position Time Status Full-Time Required Education BSN Click here for more information about equivalencies: <a href="https://hr.uky.edu/employment/working-uk/equivalencies" target="_blank">https://hr.uky.edu/employment/working-uk/equivalencies</a> Required Related Experience 1 yr Required License/Registration/Certification Registered Nurse (RN) + approved advanced national nursing certification required within 2 years of hire date Physical Requirements May include standing for greater than 5 hours at a time and possibly walking several miles per day. May require the ability to reach items above shoulder level and be able to lift up to 25 pounds. Shift Primarily Monday-Friday, with occasional evenings and weekends depending on departmental needs. Job Summary The Nurse Navigator will work with the patient and members of the clinical care team to help navigate their way to timely and quality care and to assist in overcoming any barriers to care. This will include, but is not limited to, connecting them to resources and information to make informed decisions, providing education and emotional support, and coordinating team communications. The NN will assist the patient from initial diagnosis through diagnostic testing, treatment, and follow-up or end-of-life care. The starting pay for this position was recently adjusted with the minimum annual rate set at $62,400.00/year. All pay rates will be based on the candidate’s experience. Skills / Knowledge / Abilities The ideal candidate will possess working knowledge of electronic health records for inpatient/outpatient. Strong knowledge and experience with Microsoft Office applications is encouraged. Does this position have supervisory responsibilities? No Preferred Education/Experience BSN + 1 year of experience Deadline to Apply 08/27/2025 Our University Community We value the well-being of each of our employees and are dedicated to creating a healthy place for everyone to work, learn and live. In the interest of maintaining a safe and healthy environment for our students, employees, patients and visitors the University of Kentucky is a Tobacco &amp; Drug Free campus. As an Equal Opportunity Employer, we strongly encourage veterans, individuals with disabilities, women, and all minorities to consider our employment opportunities. Any candidate offered a position may be required to pass pre-employment screenings as mandated by University of Kentucky Human Resources. These screenings may include a national background check and/or drug screen.

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