- The Arora Group (Bethesda, MD)
- …+ The Contractor shall frequently collaborate with managers of the UBO, Utilization Review Registered Nurse ( RN ) and pre-certification clerk. + The ... Licensed Practical Nurse (LPN) - Utilization Review Nurse Currently...or emergent patient care situations, seek assistance of the RN and/or MD/DO, and initiate appropriate emergency interventions as… more
- Ascension Health (Baltimore, MD)
- …qualifications and comparison with associates in similar roles_ **2 years Utilization Review experience preferred.** **Effective communication with healthcare ... providers, patients, and insurance companies to explain utilization review decisions.** **Familiarity with electronic health records and utilization … more
- Ascension Health (Baltimore, MD)
- …experience, location, qualifications and comparison with associates in similar roles_ ** Registered Nurse , Certified Case Manager (CCM, ACM, URAC) preferred ... salary range at the time of the offer._ **Responsibilities** Manage effective utilization review processes, including management of patient statusing processes… more
- Baylor Scott & White Health (Annapolis, MD)
- …vary based on position type and/or level **Job Summary** As a Manager for Utilization Review , you guide and supervise staff. You oversee care coordination across ... Factors** + Demonstrable knowledge in discharge planning, case management, utilization review and different care levels. +...work experience + Hold a valid registration as a Registered Nurse As a health care system… more
- CareFirst (Baltimore, MD)
- …is required in addition to the required work experience. **Licenses/Certifications:** + Health Services\ RN - Registered Nurse - State Licensure and/or ... detail can be shared during the interview process. Plans, organizes, and manages utilization review programs. Directs the utilization of referral services.… more
- Humana (Annapolis, MD)
- **Become a part of our caring community and help us put health first** The Utilization Management Registered Nurse 2 utilizes clinical nursing skills to ... independent determination of the appropriate courses of action. The Utilization Management Registered Nurse 2...skills to make an impact** **Required Qualifications** + **Licensed Registered Nurse ( RN )** in the… more
- Erickson Living (Parkville, MD)
- …leadership meetings such as Wound Rounds, Clinical Operations Meeting, Utilization Review , and Performance Improvement/Risk Management/Safety (PI/RM/S) Committee ... (skilled nursing, long term care, assisted living or hospital) is required. + Current Registered Nurse license for the state in which they operate. + Current… more
- Trinity Health (Silver Spring, MD)
- …the activities of hospital staff in inpatient care coordination, social work, utilization review , and discharge planning. + Collaborate with the Medical ... field (nursing, social work, healthcare administration, or medicine). + RN with active preference Maryland license highly preferred. +...2+ years in a leadership role in case management, utilization review , or similar areas. + Extensive… more
- Ascension Health (Baltimore, MD)
- …Connect with your Talent Advisor for additional specifics._ **Responsibilities** Manage assigned Registered Nurse ( RN ) case managers, related activities and ... including but not limited to: Access Authorization and pre-certification, utilization review and denial management, CareCoordination, Collaborative treatment… more
- Fresenius Medical Center (Baltimore, MD)
- …auditing activities. + Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. + Manages clinic ... financials including efficient utilization of supplies or equipment and regular profits and...of supplies or equipment and regular profits and loss review . + Responsible for all required network reporting and… more
- Ivyhill Technologies LLC (Bethesda, MD)
- …referral management services for beneficiaries in the Defense Health Network. Registered Nurse will have overall responsibility for timely review of Right of ... of Specialty Care Referrals, sustaining up-to-date Specialty Clinic Referral Review tools and booking guidance, complying with Referral and...RM Team. Requirements Qualified candidate must be a Licensed Registered Nurse ( RN ), with an… more
- CareFirst (Baltimore, MD)
- …people. **QUAIFICATIONS:** **Education Level:** High School Diploma or GED. **Licenses/Certifications:** + RN - Registered Nurse - State Licensure And/or ... **Resp & Qualifications** **PURPOSE:** The Clinical Appeals Supervisor ( RN ) directs and coordinates the accurate implementation of...clinical experience OR + 5 years experience in Medical Review , Utilization Management or Case Management at… more
- The Cigna Group (Baltimore, MD)
- The RN Coordinator serves as the key contact point for...as needed 3) 3+ years of experience as a Registered Nurse 4) Proficient level of experience with ... and make specific recommendations based on their goals 4. Review paperwork for patients to ensure it meets all...of the team to manage heath care cost and utilization **Provider Support** 1. Completes telephonic nursing assessments including… more
- CareFirst (Baltimore, MD)
- …experience is required in addition to the required work experience. **Licenses/Certifications:** + RN - Registered Nurse - State Licensure And/or Compact ... State Licensure RN - Registered Nurse in MD, VA orWashington, DC...working in Care Management, Home Health, Discharge Coordination and/or Utilization Review . **Preferred Qualifications:** + Knowledge and… more
- Sharecare (Annapolis, MD)
- …support appropriate total healthcare management and ensure cost effective, appropriate resource utilization and quality outcomes. The RN is also responsible for ... Hours are on Central Standard Time. **Job Summary:** The RN has the responsibility for supporting the goals and...orientation and to take the pre and posttests to review competency during orientation. Yearly competency test is required… more
- Erickson Living (Silver Spring, MD)
- …of medical practice; insurance benefit structures and related legal/medical issues; and utilization review and quality assurance procedures. Please note that ... consecutive year!_** Join our 5-star rated team as a RN Case Manager (also known as Care Coordinator, Erickson...+ Researches and selects care options as appropriate. The nurse care coordinator may utilize a range of alternative,… more
- CareFirst (Baltimore, MD)
- … Review , Disease Management, or other direct patient care experience. **Licenses/Certifications:** RN - Registered Nurse - State Licensure And/or Compact ... determinant of health needs. Engage members and providers to review and clarify treatment plans ensuring alignment with medical...State Licensure RN - Registered Nurse in MD, VA or Washington,… more
- CareFirst (Baltimore, MD)
- …**Education Level:** High School Diploma or GED. **Licenses/Certifications:** + **Upon Hire Required:** RN - Registered Nurse - Compact State Licensure ... RN - Registered Nurse in MD, VA, and/or State Licensure in Washington,...experience working in Care Management, Discharge Coordination, Home Health, Utilization Review , Disease Management or other direct… more
- Highmark Health (Annapolis, MD)
- …Sunday required in addition to 3 weekdays** This job implements effective utilization management strategies including: review of appropriateness of health care ... services, application of criteria to ensure appropriate resource utilization , identification of opportunities for referral to a Health Coach/case management, and… more
- Highmark Health (Annapolis, MD)
- …+ Licensed Marriage and Family Therapist (LMFT) + Licensed Behavior Specialist + Registered Nurse . **Preferred** + None **SKILLS** + Working knowledge of ... Remote - Part Time - Weekends Required.** This job implements the effective utilization management strategies including: review of appropriateness of health care… more