- CVS Health (Washington, DC)
- …And we do it all with heart, each and every day. **Position Summary** The ** Utilization Management Clinical Nurse Consultant** utilizes clinical ... Arizona Time Zone. **Preferred Qualifications** : + Previous experience with utilization management . + Previous clinical experience in Emergency Department,… more
- CenterWell (Washington, DC)
- …RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to ... Therapy, DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare… more
- AmeriHealth Caritas (Washington, DC)
- **$5,000.00 SIGN ON BONUS** **Role Overview** Our Utilization Management Reviewers evaluate medical necessity for inpatient and outpatient services, ensuring ... in the least restrictive and most effective manner. The Utilization Management Reviewer must maintain a strong...(BSN) preferred + Minimum of 3 years of diverse clinical experience as a Registered Nurse in… more
- Immigration and Customs Enforcement (Washington, DC)
- …with the IHSC Medical Quality Management Unit. SUPERVISORY CONTROLS: The Clinical Senior Nurse Specialist, Medical Asset Support Team (MAST) member works ... of complex tasks requiring developed proficiency/ higher responsibility: serving as Clinical Coordinator/ Acting Nurse Manager/ Acting Regional Nurse… 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. ... physician-developed medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care… more
- Fresenius Medical Center (Washington, DC)
- **About this role:** As a Clinical Manager with Fresenius Medical Care, you will ensure that quality patient care is delivered while maintaining clinical ... or chronic kidney disease. **Training and advancement:** You will enter our Clinical Leadership Program that creates and supports a culture of continuous learning… more
- Veterans Affairs, Veterans Health Administration (Washington, DC)
- …to patient groups, maximizing utilization of resources, and enhancing the case management program. The nurse 's primary commitment is to the patient, whether ... Summary The Psychosocial Rehabilitation and Recovery Center Nurse role is to collaboratively manage, coordinate and...care, and minimizing health care costs. Responsibility includes the utilization of general clinical nursing skills and… more
- Battelle Memorial Institute (Arlington, VA)
- …as a case manager by a recognized certifying organization, ie, Commission for Case Management Certification or American Nurse Credentialing Center + At least two ... Research and Analytics (HRA) business line is seeking a highly motivated, full-time ** Nurse Case Manager** to join our team in support of our government customer,… more
- CVS Health (Washington, DC)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... self-insured clients. + Application and/or interpretation of applicable criteria and clinical guidelines, standardized care management plans, polices, procedures… more
- Veterans Affairs, Veterans Health Administration (Washington, DC)
- …and analysis for the purpose of improving care to patient groups, maximizing utilization of resources and enhancing the case management program. Adhere to ... Summary The Intensive Community Mental Health Program (ICMHR) Registered Nurse (RN) is a member of the Behavioral Health Care Service Line whose role is to… more
- Veterans Affairs, Veterans Health Administration (Washington, DC)
- Summary The primary purpose of the Registered Nurse - Primary Care/CBOC Case Manager position is to demonstrate leadership in delivering and improving holistic care ... complex patients in the assigned area. The incumbent demonstrates clinical competence in the assessing, planning, implementing, coordinating, monitoring, evaluating… more
- Ivyhill Technologies LLC (Bethesda, MD)
- …program. Must have three (3) years of clinical nursing experience. Referral Management (RM) and Utilization Management (UM) experience is preferred. ... Ivyhill is currently seeking to hire a Registered Nurse (Non-Practicing) to support its contract with the Integrated Referral Management and Appointing Center… more
- Trinity Health (Silver Spring, MD)
- …needs. As the designated Nurse Supervisor, you'll coordinate staffing, resource management , and clinical workflows to ensure optimal outcomes and regulatory ... **Employment Type:** Full time **Shift:** Day Shift **Description:** ** Clinical Nurse Supervisor - Dialysis** **Location: Holy Cross Hospital** **Employment… more
- Trinity Health (Silver Spring, MD)
- …Advancement Program + **Location:** Holy Cross Health, Silver Spring, MD **Description:** The Nurse Supervisor is a designated clinical leader for a patient care ... **Employment Type:** Full time **Shift:** Day Shift **Description:** **Job Title:** Nurse Supervisor- IMC **Employment** **Type:** Full time / Day Shift… more
- Elevance Health (Washington, DC)
- …with providers, claims or service issues. + Assists with development of utilization /care management policies and procedures, chairs and schedules meetings, as ... ** Nurse Case Manager Sr** **Location:** Washington, DC. This... Case Manager Sr** will be responsible for care management within the scope of licensure for members with… more
- Trinity Health (Silver Spring, MD)
- …Day 1 Benefits, 10k Sign-on Bonus & More** As a Home Health Registered Nurse , you'll provide in-home skilled nursing care to patients by developing personalized care ... this role offers a rewarding opportunity to apply your clinical expertise in a more independent, patient-focused environment. **Why...savings that make a difference. + **Supportive Leadership** Our management team is here to help you succeed every… more
- Trinity Health (Silver Spring, MD)
- **Employment Type:** Full time **Shift:** Rotating Shift **Description:** **General Summary:** The Nurse in Charge (NIC) is a designated clinical leader for a ... and accountable for: + Cost effective decision-making regarding operations including utilization and application of resources. (ie, human resources, patient care… more
- Deloitte (Washington, DC)
- … registered nurse , physician, physician assistant, case manager, clinical documentation specialist, utilization review, informatics RN, Quality, DRG ... and informal education of physicians, CDI team, health information management and other clinical staff + Develop...medical degree, or physician assistant required + Current Registered Nurse (RN) license required + Certified Clinical … more
- Howard University Hospital (Washington, DC)
- Clinical Nursing Administration Per Diem: As needed With over 150 years of caring for our community and each other in the Washington DC area, Howard University ... patient outcomes. Howard University Hospital seeks to hire a Clinical Nursing Administrator who will embrace our rich and...patients. The incumbent assists in the formulation of a nurse float pool and coordinates the daily use of… more
- Elevance Health (Ashburn, VA)
- …in process improvement initiatives to improve the efficiency and effectiveness of the utilization reviews within the medical management processes. + Assesses and ... Commonwealth of Virginia is required. + Requires a minimum of 6 years of clinical experience and/or utilization review experience. + Requires HS diploma or… more