- Humana (Annapolis, MD)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** Supervise the daily operations of the utilization management (UM) department functions to ensure appropriate coordination ... (all benefits/incentives are subject to eligibility requirements). **Department** Clinical Utilization Management **Equal Employment Opportunity** CareFirst BlueCross… more
- Ascension Health (Baltimore, MD)
- **Details** + **Department:** Utilization Management + **Schedule:** On-site, Monday-Friday, 8:00AM-4:30PM. Must be available as needed to address urgent or ... Two years of related experience is required. **Additional Preferences** + **5 years Utilization Management experience, 2 years management or supervisory… more
- Johns Hopkins University (Baltimore, MD)
- …The Research Nurse Manager will be responsible for the overall management of the clinical trials portfolio and clinical research activities within the UAD ... We are seeking a **_CO_** **_Research Nurse Manager_** to work under the Director of...and regulatory specialists), developing and implementing effective clinical trials management strategies including data management and regulatory… more
- Veterans Affairs, Veterans Health Administration (Washington, DC)
- …education, orientation, competencies and providing quality improvement and outcomes utilization consultation. Responsibilities The primary purpose of the Intravenous ... nursing staff, and the multidisciplinary team on intravenous therapy and management . Demonstrates understanding of infection control precautions appropriate for the… more
- CareFirst (Baltimore, MD)
- …Upon Hire Preferred **Preferred Qualifications:** + 2 years' experience in Medical Review, Utilization Management or Case Management at CareFirst BlueCross ... of regulatory and accreditation requirements, understanding of appeals process and utilization management , and systems software used in processing appeals.… more
- Trinity Health (Silver Spring, MD)
- …and patients often require cardiac telemetry monitoring and/or mechanical ventilator support. The Nurse in Charge (NIC) is a designated clinical leader for a patient ... and accountable for: + Cost effective decision-making regarding operations including utilization and application of resources. (ie, human resources, patient care… more
- Johns Hopkins University (Baltimore, MD)
- The Department of Surgery, Bayview Campus is seeking a **_CO Nurse Practitioner_** (Mid-Level Provider - MLP) to work collaboratively within a multidisciplinary ... limited to the following advance procedures, wound care and management , suture and staple removal; phlebotomy, IV placement, removal...4, 5 drugs under the guidelines of the Maryland Nurse Practice Act and the DEA. _Research Coordination_ +… more
- Elevance Health (Hanover, MD)
- …in an ambulatory or hospital setting or minimum of 1 year of prior utilization management , medical management and/or quality management , and/or ... required. **Preferred Skills, Capabilities, and Experiences** **:** + Familiarity with Utilization Management Guidelines, ICD-9 and CPT-4 coding, and managed… more
- Erickson Living (Silver Spring, MD)
- Location: Riderwood Village by Erickson Senior Living The Nurse Practitioner, Employee Health and Well-Being, under general supervision from the National Medical ... health, provides high quality, efficient and cost-effective acute care, injury management , community outbreak management , new hire assessments, immunizations,… more
- Actalent (Columbia, MD)
- …Experience with electronic health records and discharge planning. + Knowledge of utilization management and prior authorization processes. + Experience in acute ... and IV therapeutic medications in accordance with LPN/LVN state nurse practice act. Essential Skills + High school graduate...Minimum of 3 years of experience as a practical nurse . + Current LPN state license and registration with… more
- CareFirst (Baltimore, MD)
- …acute clinical experience, previous case management , discharge planning or utilization review experience. **Licenses/Certifications** RN - Registered Nurse - ... **Resp & Qualifications** **PURPOSE:** The Clinical Medical Review Nurse handles day to day review of professional and institutional claims and provider appeals that… more
- Koniag Government Services (Camp Springs, MD)
- …Koniag Government Services company, is seeking a full time Occupational Health Registered Nurse to support **KPS** and our government customer in Camp Springs, MD. ... provided. + Prepare and submit required reports, including quarterly and annual utilization reports + Manage and maintain medical equipment and supplies + Provide… more
- Trinity Health (Silver Spring, MD)
- …and accountable for: + Cost effective decision-making regarding operations including utilization and application of resources. (ie, human resources, patient care ... including orientation and training. + Participating in performance evaluation and management including verbal coaching and counseling. + Participating in the… more
- The Cigna Group (Baltimore, MD)
- …education including possible side effects, plan of care, and individualized care goals management in a culturally sensitive and acceptable manner for the patient or ... works as part of the team to manage heath care cost and utilization **Provider Support** 1. Completes telephonic nursing assessments including social determinants of… more
- CareFirst (Baltimore, MD)
- …leadership experience. + Master's in Science Nursing or related field, Legal Nurse Consultant, Utilization Management , and Government Program experience ... of regulatory and accreditation requirements, understanding of appeals process and utilization management , and systems software used in processing appeals.… more
- Trinity Health (Silver Spring, MD)
- …Aides and LPNs as needed. Provides therapeutic intervention, overall care management and achievement of top decile client outcomes and patient satisfaction. ... active involvement in quality improvement activities. + Provides ongoing care management oversight/activities to assigned patients to achieve high quality care,… more
- Fresenius Medical Center (Lanham, MD)
- …staff training, equipment, physician and patient relations, cost containment, supply management , medical records, patient billing, OSHA and all company, state and ... by working with the Vice President of Quality and other organization management to ensure that organization/ASC policies and procedures are followed. + Responsible… more
- Fresenius Medical Center (Baltimore, MD)
- …Classification of Disease (ICD) coding. + Manages clinic financials including efficient utilization of supplies or equipment and regular profits and loss review. + ... + Preferred but not required: + 3+ years supervisory or project/program management experience. + Med/surg or ICU/CCU experience. **PHYSICAL DEMANDS AND WORKING… more
- Evolent (Annapolis, MD)
- …for operational performance of physician, nursing, and shared services staff in the utilization management value chain + Owns clinical rationale for ... point of responsibility for all clinical operations inclusive of nurse , physician, and shared services performance. and core work...utilization management decisions made by all clinical staff + Ensures… more