- Humana (Annapolis, MD)
- **Become a part of our caring community and help us put health first** The Utilization Management Registered Nurse 2 utilizes clinical nursing skills to ... independent determination of the appropriate courses of action. The Utilization Management Registered Nurse...skills to make an impact** **Required Qualifications** + **Licensed Registered Nurse ( RN )** in the… more
- Ascension Health (Baltimore, MD)
- …and salary range at the time of the offer._ **Responsibilities** Manage effective utilization review processes, including management of patient statusing ... location, qualifications and comparison with associates in similar roles_ ** Registered Nurse , Certified Case Manager (CCM, ACM,...the areas of utilization criteria, appeal and review process, and case management system documentation.… more
- CareFirst (Baltimore, MD)
- …is required in addition to the required work experience. **Licenses/Certifications:** + Health Services\ RN - Registered Nurse - State Licensure and/or ... Hire Required. **Experience:** 8 years' Experience in a clinical and utilization review role. 3 years Management experience. **Preferred Qualifications:** +… more
- Trinity Health (Silver Spring, MD)
- …management or related field, with 2+ years in a leadership role in case management , utilization review , or similar areas. + Extensive understanding of ... of hospital staff in inpatient care coordination, social work, utilization review , and discharge planning. + Collaborate...payer mechanisms and clinical utilization management . + Strong interpersonal skills with… more
- Fresenius Medical Center (Baltimore, MD)
- …auditing activities. + Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. + Manages clinic ... financials including efficient utilization of supplies or equipment and regular profits and...of supplies or equipment and regular profits and loss review . + Responsible for all required network reporting and… more
- The Cigna Group (Baltimore, MD)
- The RN Coordinator serves as the key contact point for...as needed 3) 3+ years of experience as a Registered Nurse 4) Proficient level of experience with ... and make specific recommendations based on their goals 4. Review paperwork for patients to ensure it meets all...side effects, plan of care, and individualized care goals management in a culturally sensitive and acceptable manner for… more
- Highmark Health (Annapolis, MD)
- …and Sunday required in addition to 3 weekdays** This job implements 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
- Sharecare (Annapolis, MD)
- …appropriate total healthcare management and ensure cost effective, appropriate resource utilization and quality outcomes. The RN is also responsible for ... and their Primary Care Provider according to the disease management program intervention guidelines. An RN is...orientation and to take the pre and posttests to review competency during orientation. Yearly competency test is required… more
- CareFirst (Baltimore, MD)
- …people. **QUAIFICATIONS:** **Education Level:** High School Diploma or GED. **Licenses/Certifications:** + RN - Registered Nurse - State Licensure And/or ... **Resp & Qualifications** **PURPOSE:** The Clinical Appeals Supervisor ( RN ) directs and coordinates the accurate implementation of...clinical experience OR + 5 years experience in Medical Review , Utilization Management or Case… more
- Highmark Health (Annapolis, MD)
- …Remote - Part Time - Weekends Required.** This job implements the effective utilization management strategies including: review of appropriateness of health ... and offers interventions and/or alternatives. **ESSENTIAL RESPONSIBILITIES:** + Implement care management review processes that are consistent with established… more
- Ascension Health (Baltimore, MD)
- …Connect with your Talent Advisor for additional specifics._ **Responsibilities** Manage assigned Registered Nurse ( RN ) case managers, related activities and ... functions, including but not limited to: Access Authorization and pre-certification, utilization review and denial management , CareCoordination,… more
- Amergis (Hunt Valley, MD)
- The Registered Nurse - Hospice Case Manager is responsible for providing care, comfort and support to terminally ill patients. The Registered Nurse - ... delivery of hospice patient care in various settings. The Registered Nurse demonstrates the ability to make...in managing patient care and assisting others in the management of patient care. Position Details: + Location: Baltimore… more
- CareFirst (Baltimore, MD)
- …, Disease Management , or other direct patient care experience. **Licenses/Certifications:** RN - Registered Nurse - State Licensure And/or Compact ... **Experience:** 5 years clinically related experience working in Care Management , Discharge Coordination, Home Health, Utilization ...State Licensure RN - Registered Nurse in MD, VA or Washington,… more
- CareFirst (Baltimore, MD)
- …**Education Level:** High School Diploma or GED. **Licenses/Certifications:** + **Upon Hire Required:** RN - Registered Nurse - Compact State Licensure ... RN - Registered Nurse in MD, VA, and/or State Licensure in Washington,...in Care Management , Discharge Coordination, Home Health, Utilization Review , Disease Management or… more
- CareFirst (Baltimore, MD)
- …experience is required in addition to the required work experience. **Licenses/Certifications:** + RN - Registered Nurse - State Licensure And/or Compact ... with dynamic goals resulting in the full and fair review of appeals and designed to achieve corporate objectives...+ Master's in Science Nursing or related field, Legal Nurse Consultant, Utilization Management , and… more
- Erickson Living (Parkville, MD)
- …clinical leadership meetings such as Wound Rounds, Clinical Operations Meeting, Utilization Review , and Performance Improvement/Risk Management /Safety ... and processes in accordance with the Erickson Senior Living Management Policies and Procedures and nursing standards of practice....care, assisted living or hospital) is required. + Current Registered Nurse license for the state in… more
- Guardian Life (Annapolis, MD)
- …services. Act as a liaison between all parties required in case management to facilitate collaboration toward RTW goals. Utilization of independent ... **Position Summary** The RN Clinical Consultant serves as a clinical resource...issues, when possible, to enhance the customer experience. **Activity** Review and assess claimant subjective reports and objective medical… more
- Erickson Living (Silver Spring, MD)
- …of medical practice; insurance benefit structures and related legal/medical issues; and utilization review and quality assurance procedures. Please note that ... consecutive year!_** Join our 5-star rated team as a RN Case Manager (also known as Care Coordinator, Erickson...+ Researches and selects care options as appropriate. The nurse care coordinator may utilize a range of alternative,… more
- CareFirst (Baltimore, MD)
- …experience is required in addition to the required work experience. **Licenses/Certifications:** + RN - Registered Nurse - State Licensure And/or Compact ... State Licensure RN - Registered Nurse in MD, VA orWashington, DC...Care Management , Home Health, Discharge Coordination and/or Utilization Review . **Preferred Qualifications:** + Knowledge and… more
- Johns Hopkins University (Lutherville, MD)
- …+ Bachelor's Degree in Nursing or related field. + Individual must be a registered nurse , licensed in the State of Maryland or state where practicing. ... The Department of Otolaryngology is seeking a **_CO_** **_Clinical Nurse Manager_** the Clinical Nurse Manager collaborates...annual clinical operating budget. + Monitors inventory and supply management for the clinic. + Review safety… more