• UM Nurse -Compact RN License Required

    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
    Humana (01/03/25)
    - Save Job - Related Jobs - Block Source
  • Utilization Management Director…

    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 (11/26/24)
    - Save Job - Related Jobs - Block Source
  • Utilization Management Specialist…

    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
    CareFirst (11/07/24)
    - Save Job - Related Jobs - Block Source
  • RN- Utilization Review

    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 (12/28/24)
    - Save Job - Related Jobs - Block Source
  • RN Manager- Utilization Review

    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
    Ascension Health (12/17/24)
    - Save Job - Related Jobs - Block Source
  • Clinical Reviewer, Nurse - Cardiac

    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
    Evolent (01/03/25)
    - Save Job - Related Jobs - Block Source
  • CO Clinical Nurse Manager

    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 (10/31/24)
    - Save Job - Related Jobs - Block Source
  • CO Research Nurse Manager

    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
    Johns Hopkins University (12/19/24)
    - Save Job - Related Jobs - Block Source
  • Quality Review Nurse (Remote)

    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 (11/15/24)
    - Save Job - Related Jobs - Block Source
  • Clinical Appeals Nurse (Remote)

    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
    CareFirst (11/09/24)
    - Save Job - Related Jobs - Block Source
  • Nurse Supervisor Multi Environment Night…

    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
    Trinity Health (12/13/24)
    - Save Job - Related Jobs - Block Source
  • CO Nurse Practitioner

    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
    Johns Hopkins University (12/12/24)
    - Save Job - Related Jobs - Block Source
  • Registered Nurse (Non-Practicing)…

    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
    Ivyhill Technologies LLC (12/10/24)
    - Save Job - Related Jobs - Block Source
  • Acute Inpatient Charge Registered Nurse

    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
    Fresenius Medical Center (12/31/24)
    - Save Job - Related Jobs - Block Source
  • Clinical Appeals Manager - RN (Hybrid)

    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
    CareFirst (11/09/24)
    - Save Job - Related Jobs - Block Source
  • Nurse in Charge-Weekend

    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
    Trinity Health (10/24/24)
    - Save Job - Related Jobs - Block Source
  • Nurse Reviewer I

    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
    Elevance Health (01/03/25)
    - Save Job - Related Jobs - Block Source
  • Employee Health Nurse Practitioner

    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
    Erickson Living (01/01/25)
    - Save Job - Related Jobs - Block Source
  • Full Time Occupational Health Registered…

    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
    Koniag Government Services (11/09/24)
    - Save Job - Related Jobs - Block Source
  • Nurse Supervisor Muti Environmnet IMCU Unit

    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
    Trinity Health (01/04/25)
    - Save Job - Related Jobs - Block Source