- 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
- CareFirst (Baltimore, MD)
- …Licensure Upon Hire Required. **Experience:** 8 years' Experience in a clinical and utilization review role. 3 years Management experience. **Preferred ... based on business needs and work activities/deliverables that week. The Director, Utilization Management provides strategic leadership of the utilization … more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** Supervise the daily operations of the utilization management (UM) department functions to ensure appropriate coordination ... accreditation standards and federal/state regulations and general principles relating to utilization review . + Computer skills, including Microsoft Office… 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 (Woodlawn, 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
- 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
- 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
- CareFirst (Baltimore, MD)
- …performed the duties of Care Management , Discharge Coordination, Home Health, Utilization Review , Disease Management and/or other direct patient care ... **Resp & Qualifications** **PURPOSE:** Under minimal supervision, the Obstetric Nurse Care Manager researches and analyzes an Obstetric member's medical and… more
- CareFirst (Baltimore, MD)
- …working in Care Management , Home Health, Discharge Coordination and/or Utilization Review . **Preferred Qualifications:** + Knowledge and experience with ... of care utilizing experience and skills in both case management and utilization management . This...to discharge. We are looking for an experienced Registered Nurse with NICU and pediatric experience living within the… more
- Ascension Health (Baltimore, MD)
- …functions, including but not limited to: Access Authorization and pre-certification, utilization review and denial management , CareCoordination, ... specialist for staff in the areas of utilization criteria, appeal and review process, and case management system documentation. + Develop staff schedule and… more
- Erickson Living (Parkville, MD)
- …clinical leadership meetings such as Wound Rounds, Clinical Operations Meeting, Utilization Review , and Performance Improvement/Risk Management /Safety ... clinical practice and processes in accordance with the Erickson Senior Living Management Policies and Procedures and nursing standards of practice. + Ownership of… 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
- CareFirst (Baltimore, MD)
- …of regulatory and accreditation requirements, understanding of appeals process and utilization management , and systems software used in processing appeals. ... of members for all lines of business. Ensures quality management of the clinical appeal process to reduce the...with dynamic goals resulting in the full and fair review of appeals and designed to achieve corporate objectives… more
