- Humana (Arlington, VA)
- …professional onsite, field, or remote based opportunities. The Prior Authorization, Registered Nurse , RN , Intern will utilize Humana's Medicaid training ... the goal to put health first? The Prior Authorization, Registered Nurse , RN , Intern will...experience a plus. + Previous experience in prior authorization, utilization management + Experience working with MCG… more
- Veterans Affairs, Veterans Health Administration (Washington, DC)
- …equivalent to a bachelor's level degree in Nursing may have opportunity to become registered as a nurse with a state licensing board prior to completion ... Summary The Intravenous RN is responsible for providing competent, evidence-based care to assigned patients and oversight of licensed vocational nurses/nursing… more
- Highmark Health (Washington, DC)
- …Sunday required in addition to 3 weekdays** This job implements effective utilization management strategies including: review of appropriateness of health care ... depending on where clinical care is being provided. **Preferred** + Certification in utilization management or a related field **SKILLS** + Working knowledge of… more
- Guardian Life (Washington, DC)
- …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...plan and length of disability. Plan for ongoing case management through proactive partnering with treating providers to move… more
- Somatus (Mclean, VA)
- …utilizing basic nursing knowledge, experience and skills to ensure appropriate utilization of resources and patient quality outcomes. Performs care management ... telephonically as the need arises. **This is a fully remote role where compact licensure is strongly preferred.** **The...Uses protocols and pathways in line with established disease management and care management programs and approved… more
- Molina Healthcare (Alexandria, VA)
- **JOB DESCRIPTION** For this position we are seeking a ( RN ) Registered Nurse or LCSW who lives in VIRGINIA and must be licensed for the state of VIRGINIA. ... performing one or more of the following activities: care review/ utilization management (prior authorizations, inpatient/outpatient medical necessity, etc.),… more
- United Therapeutics (Annapolis, MD)
- …Degree preferably in a health, biological sciences, or related field or + Registered Nurse ( RN ) nursing qualifications or relevant clinical research ... with superior financial performance and our communities with earth-sensitive energy utilization . Our company was founded by an entrepreneur whose daughter was… more
- Humana (Washington, DC)
- …your skills to make an impact** **Required Qualifications** + Associate degree + Active Registered Nurse , ( RN ), License in your state of residence without ... project management and/or process improvement experience + Minimum 3 years utilization management experience with exposure to grievance and appeals +… more
- Elevance Health (Alexandria, VA)
- …Care Coordinator** Location: Candidate must reside in Northern Virginia. While primarily remote , occasional travel is required to meet with members face to face. ... or face-to-face assessments for the identification, evaluation, coordination and management of member's needs, including physical health, behavioral health, social… more