- Humana (Annapolis, MD)
- …part of our caring community and help us put health first** The Utilization Management Behavioral Health Nurse uses behavioral health knowledge and ... licensed in a Compact State** The Utilization Management Behavioral Health Nurse completes...Qualifications** + Minimum of Associate Degree in Nursing + Registered Nurse ( RN ) licensure with… more
- CareFirst (Baltimore, MD)
- …is required in addition to the required work experience. **Licenses/Certifications:** + Health Services\ RN - Registered Nurse - State Licensure and/or ... based on business needs and work activities/deliverables that week. The Director, Utilization Management provides strategic leadership of the utilization … more
- CareFirst (Baltimore, MD)
- …5 years Clinical nursing experience, 2 years Care Management . **Licenses/Certifications** RN - Registered Nurse - State Licensure And/or Compact ... **Resp & Qualifications** **PURPOSE:** Utilizing key principles of utilization management , the Utilization Review Specialist will perform prospective,… more
- CareFirst (Baltimore, MD)
- …standards. **QUALIFICATIONS:** **Education Level:** High School Diploma or GED. **Licenses/Certifications:** + RN - Registered Nurse - State Licensure And/or ... Compact State Licensure RN - Registered Nurse in MD, VA or Washington,...specialty. Within that specialty performed the duties of Care Management , Discharge Coordination, Home Health, Utilization Review,… more
- CareFirst (Baltimore, MD)
- …experience is required in addition to the required work experience. **Licenses/Certifications:** + RN - Registered Nurse - State Licensure And/or Compact ... of care utilizing experience and skills in both case management and utilization management . This...State Licensure. RN - Registered Nurse in MD, VA or Washington,… more
- CareFirst (Baltimore, MD)
- …+ Ability to provide excellent internal and external customer service. **Licenses/Certifications:** RN - Registered Nurse - State Licensure And/or ... **Experience:** 5 years clinically related experience working in Care Management , Discharge Planning, Care Coordination, Home Health, Utilization...Compact State Licensure RN - Registered Nurse in MD, VA, or Washington,… more
- BrightSpring Health Services (Baltimore, MD)
- …Education: + Bachelor's Degree in Nursing or the equivalent + Currently licensed as a Registered Nurse ( RN ), in good standing in state of residence ... and direction in performance improvement, provision of clinical services, survey management , documentation management , incident management , EMR/EHR… more
- WellSpan Health (York, PA)
- …6 years in nursing with Leadership experience in hospital/healthcare Required Licenses: + Licensed Registered Nurse Upon Hire Required or + Registered ... team approach to the delivery of patient care for inpatient services, behavioral health services, and various ambulatory services, with a focus on Emergency… more
- CareFirst (Baltimore, MD)
- …Executive Vice President, Health Services, this position leads and oversees Case Management , Utilization Management including prior authorization, and post ... Vice President of Clinical Operations is accountable for both behavioral health and medical care management at...management at all stages of the health continuum, utilization management decisions themselves and the consequences… more
- Highmark Health (Annapolis, MD)
- …and education or if necessary involve Special Investigation Unit or the Utilization Management area. **ESSENTIAL RESPONSIBILITIES** + Implement the pre-payment ... data to assure appropriate level of payment and resource utilization . It is also used to identify issues which...experience in Managed Care **LICENSES or CERTIFICATIONS** **Required** + Registered Nurse **Preferred** + Certified Medical Coder… more