- Humana (Annapolis, MD)
- …community and help us put health first** Full-Time, Remote Telephonic opportunity The Utilization Management Nurse 2 utilizes clinical nursing skills to ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...appropriate courses of action. As a Utilization Management RN working on the OneHome/ Home Solutions… more
- CenterWell (Annapolis, MD)
- …RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability ... Therapy, DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare… more
- 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
- 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...3 years of diverse clinical experience as a Registered Nurse in an Intensive Care Unit (ICU), Emergency Department… more
- Veterans Affairs, Veterans Health Administration (Washington, DC)
- Summary The Same Day Procedure Unit (SDPU) Registered Nurse (RN) provides care to patients prior to and immediately after various surgeries and procedures. The SDPU ... care duties such as physical assessment, obtaining labs, obtaining EKG, management of belongings, confirming consent, history and physical. Responsibilities The Same… 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 ... for patient's health care options and services. Responsibilities The Registered Nurse is responsible for providing competent, evidence-based care to assigned… more
- Evolent (Annapolis, MD)
- …Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. Tasks are performed ... medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care across the continuum… more
- Fresenius Medical Center (Washington, DC)
- …Quality, and Technical Services departments. + Collaborates with or functions as the Home Therapies Program Manager to oversee the facility's Home Therapies ... Classification of Disease (ICD) coding. + Manages clinic financials including efficient utilization of supplies or equipment and regular profits and loss review. +… more
- CenterWell (Annapolis, MD)
- …and reliable transportation. + Two years as a Registered Nurse in a home care, with at least one-year of management experience preferred. **Scheduled Weekly ... patient information related to the case, including disciplines required, to determine home health or hospice needs. Accountable to ensure patients meet admission… more
- Sharecare (Annapolis, MD)
- …/ new hire plan selection, claims issues, ID card issues, grievances/appeals, utilization management (UM) status, including but not limited to medical, ... + Claims adjustments + Grievances and appeals submissions + Utilization management intake or status + Complex...and second opinion. + Referring members to Clinical Advocates ( Nurse ) for conditions that require clinical care and case… more
- Humana (Annapolis, MD)
- …others. **Essential Duties and Responsibilities:** + Review PA requests for home health services, durable medical equipment, outpatient therapies, skilled nursing ... inpatient and subacute activity daily for outcomes related to readmission, utilization , quality of care and provider performance in compliance with Humana/iCare… more