- Humana (Washington, DC)
- …of our caring community and help us put health first** The Staff Utilization Management Pharmacist is a clinical expert responsible for conducting ... holiday per calendar year** **Job Description:** The Staff Utilization Management Pharmacist is a clinical professional responsible for conducting… more
- Elevance Health (Ashburn, VA)
- ** Utilization Management Medical Director- NC Medicaid** Location: This role enables associates to work virtually full-time, with the exception of required ... Alternate locations may be considered. The **Medical Director** will be responsible for utilization review case management for North Carolina Medicaid. May be… more
- Evolent (Washington, DC)
- …a Clinical Reviewer, Nurse, you will routinely interact with leadership and management staff , other CR's ( Clinical Reviewers), providers, office staff ... Nurse, you will be a key member of the utilization management team. We can offer you...standards in the participating provider network and for other clinical staff . + Converses with medical office… more
- Howard University Hospital (Washington, DC)
- …a clinical specialist resource for pharmacists, nurses and physicians. Provides clinical staff development services and instruction within area of expertise ... to pharmacy staff . Assists with evaluation of staff clinical activities and interventions. Documents clinical activities that include, but are not… more
- Immigration and Customs Enforcement (Washington, DC)
- …health facility surveyors and in collaboration with the IHSC Medical Quality Management Unit. SUPERVISORY CONTROLS: The Clinical Senior Nurse Specialist, Medical ... Summary This position supports nursing staff , advances nursing practices, and contributes to the...providing direct patient care at various IHSC facilities, offering clinical and administrative nursing support, and collaborating with the… more
- Amgen (Washington, DC)
- …experience in the utilization of molecular imaging as a quantitative biomarker in clinical trials + Experience with the utilization of clinical MR ... team. Join us and transform the lives of patients while transforming your career. ** Clinical Imaging Director** **What you will do** Let's do this. Let's change the… more
- CareFirst (Washington, DC)
- …of care. Utilizing experience and skills in both care management and utilization management , the Onsite Clinical Navigator will leverage proficiency in ... hospital assignments and admissions volumes on a week-to-week basis, management may occasionally approve the Onsite Clinical ...working onsite to make rounds with members and hospital staff , participates in clinical reviews to determine… more
- Battelle Memorial Institute (Arlington, VA)
- …and organizational objectives. We will support positive programs for equal treatment of all staff and full utilization of all qualified employees at all levels ... and Analytics (HRA) business line is seeking a highly motivated, full-time **Licensed Clinical Social Worker (LCSW)** to join our team in support of our government… more
- J&J Family of Companies (Fairfax, VA)
- …beyond the EP/IC lab, including, but not limited to physicians, nurses and technicians, clinical and hospital administrators and staff . + Stay current on company ... We are searching for the best talent for **Sr. Ultrasound Clinical Account Specialist** to be in **Northern Virginia: Fairfax, Fredericksburg, Roanoke,… more
- Deloitte (Washington, DC)
- …plans for both formal and informal education of physicians, CDI team, health information management and other clinical staff + Develop in-service education ... clinical registered nurse, physician, physician assistant, case manager, clinical documentation specialist, utilization review, informatics RN, Quality, DRG… more
- Fresenius Medical Center (Washington, DC)
- …courses and that licensures/certifications are current. + Provides support for all clinical staff members at regular intervals and encourages professional ... eligibility for treatment. + Reports changes in patient status regarding any clinical , insurance, or travel and transportation issues. STAFF : + Participates… more
- Humana (Washington, DC)
- …corporate communications to be shared with senior leadership. + Supports trend management by conducting analysis of drug spend, utilization , and/or approval ... communicating with staff in different positions and all levels of management positions + Manages the Humana Michigan FIDE-SNP health plan relationship with our… more
- Trinity Health (Silver Spring, MD)
- …Type:** Full time **Shift:** Day Shift **Description:** **Job Title:** Clinical Business Manager, Neuroscience Programs **Schedule:** Full Time, Days **Department:** ... **Position Description** Holy Cross Health is seeking an experienced and dynamic Clinical Business Manager to oversee our Neuroscience Program. The Manager is… more
- Howard University Hospital (Washington, DC)
- …policy and procedures for all personnel and acts as an administrative liaison, clinical resource, and role model for staff . Responsible for triaging operational ... Clinical Nursing Administration Per Diem: As needed With...float pool and coordinates the daily use of supplement staff . The incumbent coordinates and assists in the monitoring… more
- Elevance Health (Washington, DC)
- …business unit initiatives relating to the development and implementation of a risk management program for utilization management activities. + Collaborates ... with enterprise quality teams, enterprise care management teams, and other clinical departments on regulatory initiatives. + Supports quality committee… more
- Evolent (Washington, DC)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. Tasks ... independent nursing judgement and decision-making, physician-developed medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse… more
- Evolent (Washington, DC)
- … Reviewer, Interventional Pain Management , you will be a key member of the utilization management team. We can offer you a meaningful way to make a ... better health outcomes. **Collaboration Opportunities:** + Routinely interacts with leadership and management staff , other Physicians, and staff whenever a… more
- Highmark Health (Washington, DC)
- …per week (Tuesday-Thursday).** This role supports the full application product lifecycle for ** clinical and utilization management software** , with a ... and technical teams. They function as a pivotal bridge, translating high-level ** clinical and utilization management software** business needs into… more
- Elevance Health (Ashburn, VA)
- …benefits plans will require guidance from leadership, medical directors or delegated clinical staff . + Conducts and may approve pre-certification, concurrent, ... initiatives to improve the efficiency and effectiveness of the utilization reviews within the medical management processes....required. + Requires a minimum of 6 years of clinical experience and/or utilization review experience. +… more
- Evolent (Washington, DC)
- …Cardiologist)** Are you ready to make a meaningful impact on patient care in a non- clinical setting? Join our Utilization Management team as a Field Medical ... appropriate, high-value care aligned with clinical guidelines. + Collaborate with leadership, management , and clinical staff to address complex cases and… more