- Humana (Annapolis, MD)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- CareFirst (Baltimore, MD)
- …based on business needs and work activities/deliverables that week. The Director, Utilization Management provides strategic leadership of the utilization ... and is responsible for the design, assessment, implementation and outcomes of utilization management strategies using a multidisciplinary approach to enhance… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** Utilizing key principles of utilization management , the Utilization Review Specialist will perform prospective, ... coverage. Leveraging clinical expertise and critical thinking skills, the Utilization Review Specialist, will analyze clinical information, contracts, mandates,… more
- Ascension Health (Baltimore, MD)
- **Details** + **Department:** Utilization Management + **Schedule:** On-site, Monday-Friday, start time between 7am-9am, 8 hours shift, with occasional weekends ... utilization review decisions.** **Familiarity with electronic health records and utilization management software.** **Benefits** Paid time off (PTO) Various… more
- Ascension Health (Baltimore, MD)
- **Details** + **Department:** Utilization Management + **Schedule:** On-site, Monday-Friday, 8:00AM-4:30PM. Must be available as needed to address urgent or ... Two years of related experience is required. **Additional Preferences** + **5 years Utilization Management experience, 2 years management or supervisory… more
- Evolent (Annapolis, MD)
- …Doing:** As a Clinical Reviewer, Nurse , you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... Clinical Reviewers are supported by Field Medical Directors (MDs) in the utilization management determination process. + Reviews charts and analyzes clinical… more
- Johns Hopkins University (Lutherville, MD)
- The Department of Otolaryngology is seeking a **_CO_** **_Clinical Nurse Manager_** the Clinical Nurse Manager collaborates with the Medical Director and Clinic ... staff training/ education and development. In partnership with the Clinic Supervisor, the Nurse Manager provides oversight to the clinical staff (RNs/ CMAs) in three… more
- Johns Hopkins University (Baltimore, MD)
- …The Research Nurse Manager will be responsible for the overall management of the clinical trials portfolio and clinical research activities within the UAD ... We are seeking a **_CO_** **_Research Nurse Manager_** to work under the Director of...and regulatory specialists), developing and implementing effective clinical trials management strategies including data management and regulatory… more
- CareFirst (Baltimore, MD)
- …standards and assisting with department training. Collaborates with other business units: Utilization Management , Case Management , Claims, Quality ... Management and Compliance. The Nurse , Quality Review position develops procedures and reinforce quality...+ Clinical appeals and grievance experience with government programs, Utilization Management , + Managed Care experience, Experience… more
- CareFirst (Baltimore, MD)
- …psychiatric setting. **Preferred Qualifications:** + 2 years' experience in Medical Review, Utilization Management or Case Management at CareFirst BlueCross ... of regulatory and accreditation requirements, understanding of appeals process and utilization management , and systems software used in processing appeals.… more
- Trinity Health (Silver Spring, MD)
- …and patients often require cardiac telemetry monitoring and/or mechanical ventilator support. The Nurse in Charge (NIC) is a designated clinical leader for a patient ... and accountable for: + Cost effective decision-making regarding operations including utilization and application of resources. (ie, human resources, patient care… more
- Johns Hopkins University (Baltimore, MD)
- The Department of Surgery, Bayview Campus is seeking a **_CO Nurse Practitioner_** (Mid-Level Provider - MLP) to work collaboratively within a multidisciplinary ... limited to the following advance procedures, wound care and management , suture and staple removal; phlebotomy, IV placement, removal...4, 5 drugs under the guidelines of the Maryland Nurse Practice Act and the DEA. _Research Coordination_ +… more
- Ivyhill Technologies LLC (Bethesda, MD)
- …nursing program. Must have three (3) years of clinical nursing experience. Referral Management (RM) and Utilization Management (UM) experience is preferred. ... Ivyhill is currently seeking to hire a Registered Nurse (Non-Practicing) to support its contract with the Integrated Referral Management and Appointing Center… more
- Fresenius Medical Center (Columbia, MD)
- **PURPOSE AND SCOPE:** The Inpatient Services Charge Nurse is an additional "responsibility" assigned to the Inpatient Services RN, for a limited period of time, and ... duties, as assigned by the Program Manager. The Inpatient Services Charge Nurse ensures appropriate provision of Acute Dialysis Services and treatments within… more
- CareFirst (Baltimore, MD)
- …leadership experience. + Master's in Science Nursing or related field, Legal Nurse Consultant, Utilization Management , and Government Program experience ... of regulatory and accreditation requirements, understanding of appeals process and utilization management , and systems software used in processing appeals.… more
- Trinity Health (Silver Spring, MD)
- **Employment Type:** Part time **Shift:** Weekend Shift **Description:** **Job Title:** Nurse In Charge position for the Operating Room **Employment Type:** ... Advancement Program + **Location:** Holy Cross Health, Silver Spring, MD **Description:** The Nurse in Charge (NIC) is a designated clinical leader for a patient… more
- Elevance Health (Hanover, MD)
- …in an ambulatory or hospital setting or minimum of 1 year of prior utilization management , medical management and/or quality management , and/or ... required. **Preferred Skills, Capabilities, and Experiences** **:** + Familiarity with Utilization Management Guidelines, ICD-9 and CPT-4 coding, and managed… more
- Erickson Living (Silver Spring, MD)
- Location: Riderwood Village by Erickson Senior Living The Nurse Practitioner, Employee Health and Well-Being, under general supervision from the National Medical ... health, provides high quality, efficient and cost-effective acute care, injury management , community outbreak management , new hire assessments, immunizations,… more
- Koniag Government Services (Camp Springs, MD)
- …Koniag Government Services company, is seeking a full time Occupational Health Registered Nurse to support **KPS** and our government customer in Camp Springs, MD. ... provided. + Prepare and submit required reports, including quarterly and annual utilization reports + Manage and maintain medical equipment and supplies + Provide… more
- Trinity Health (Silver Spring, MD)
- …and accountable for: + Cost effective decision-making regarding operations including utilization and application of resources. (ie, human resources, patient care ... including orientation and training. + Participating in performance evaluation and management including verbal coaching and counseling. + Participating in the… more