- University of Maryland Medical System (Baltimore, MD)
- …a selected population of patients. Facilitates the development, implementation, and ongoing management of a model for professional practice that fosters the delivery ... delivery of health care, interpretation of clinical issues, and utilization of the nursing process. Initiates and serves as...and serves as a catalyst in the development and review of standards of care and practice and clinical… more
- University of Maryland Medical System (Baltimore, MD)
- …and post procedure data components for the program through the effective utilization of the hospital medical record system. Responsible for meeting any applicable ... streamlining and process improvement in the data collection process. Applies appropriate utilization of resources necessary to obtain valid, reliable data for entry… more
- Humana (Annapolis, MD)
- …documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are ... a part of our caring community and help us put health first** The Utilization Management Registered Nurse 2 utilizes clinical nursing skills to support the… more
- Lincoln Financial Group (Annapolis, MD)
- …Experience and/or proficiency with Disability Management (STD/LTD) knowledge, Workers Compensation, Utilization Review and/or nurse case management ... Role at a Glance** We are excited to bring on a highly motivated Nurse Disability Consultant to our clinical organization. This position will be responsible for… more
- Elevance Health (Hanover, MD)
- …equivalent and a minimum of 3 years acute care clinical experience or case management , utilization management or managed care experience; or any combination ... payment. May also manage appeals for services denied ,** **continued stay review , care coordination, and discharge planning for appropriateness of treatment setting… more
- Prime Therapeutics (Annapolis, MD)
- …of post-degree clinical experience. + Experience in managed care, specialty drugs, care management and utilization review . + Meets Magellan Credentialing ... and drives every decision we make. **Job Posting Title** Infusion Referral Nurse - REMOTE **Job Description Summary** Under supervision, is responsible for performing… more
- Elevance Health (Hanover, MD)
- …**Minimum requirements:** + Requires minimum of 3 years acute care clinical experience, utilization management or managed care experience; or any combination of ... ** Nurse Medical Management Sr.** **Location:** **multiple...May also manage appeals for services denied. + Stay review , care coordination, and discharge planning for appropriateness of… more
- Elevance Health (Annapolis, MD)
- …requirements:** + Requires minimum of 3 years acute care clinical experience or case management , utilization management or managed care experience; or any ... ** Nurse Medical Management II** **Location: multiple...appeals for services denied. + Conducts precertification, continued stay review , care coordination, or discharge planning for appropriateness of… more
- Sedgwick (Annapolis, MD)
- …and consult review ; and two (2) years of experience in daily application of nurse auditing, utilization review and bill review . **Skills & ... Great Place to Work(R) Most Loved Workplace(R) Forbes Best-in-State Employer RN Bill Review **PRIMARY PURPOSE** **:** To review hospital and professional medical… more
- CenterWell (Annapolis, MD)
- …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and ... requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking...and reliable transportation. + Two years as a Registered Nurse with at least one-year of management … more
- Highmark Health (Annapolis, MD)
- …Inc. **Job Description :** **JOB SUMMARY** This job implements the effective utilization management strategies including: review of appropriateness of ... and offers interventions and/or alternatives. **ESSENTIAL RESPONSIBILITIES:** + Implement care management review processes that are consistent with established… more
- Elevance Health (Hanover, MD)
- …**How you will make an impact:** + Develops, maintains and enhances the claims review process. + Assists management with developing unit goals, policies and ... responsible for identifying, monitoring, and analyzing aberrant patterns of utilization and/or fraudulent activities by health care providers through prepayment… more
- Johns Hopkins University (Lutherville, MD)
- …and implement appropriate processes to ensure all facets of clinic practice management are effective. This may include scheduling efficiency, complete and accurate ... training of employees as needed in conjunction with the Nurse Manager, clinical trainer, and educator for PSC, CMA,...practice through Tableau and outside online survey sites. + Review monthly at CUSP the patient satisfaction reports and… more
