- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The role of the Quality Review Nurse (RN) is to evaluate clinical quality and procedures within the Clinical ... Management, Case Management, Claims, Quality Management and Compliance. The Nurse , Quality Review position develops procedures and reinforce quality … more
- Veterans Affairs, Veterans Health Administration (Baltimore, MD)
- …determined by the VHA Education Loan Repayment Services program office after review of the EDRP application. Former EDRP participants ineligible to apply. ... Responsibilities The Hospice Registered Nurse (RN) will work to maintain the comfort and quality of life for those who are diagnosed with terminal diseases and… more
- Elevance Health (Hanover, MD)
- **Diagnosis Related Group Clinical Validation Auditor-** **Registered Nurse ** **Location:** This position will work a hybrid model ( remote and office). Ideal ... documentation supports the conditions and DRGs billed and reimbursed. Specializes in review of Diagnosis Related Group (DRG) paid claims. **How you will make… more
- Highmark Health (Annapolis, MD)
- **Company :** Highmark Inc. **Job Description :** **JOB SUMMARY** **Fully Remote - Part Time - Weekends Required.** This job implements the effective utilization ... management strategies including: review of appropriateness of health care services, application of...a Health Coach/case management, and identification and resolution of quality issues. Monitors and analyzes the delivery of health… more
- United Therapeutics (Annapolis, MD)
- …and collaborate with high level site staff with minimal supervision/escalation needed + Review the quality and integrity of clinical data via Source Document ... + Provide training to site staff as needed via onsite/ remote (phone or teleconference/web meeting) on protocol, study/vendor technology,... Review /Source Data Verification (SDR/SDV) to ensure assigned study sites'… more
- Evolent (Annapolis, MD)
- …more than 70 plans and risk-bearing provider groups to better manage both the quality and cost of care. Through a comprehensive suite of resources-such as high-value ... rising cost of health care is unsustainable, and we believe every patient deserves higher quality care at lower costs. Founded in 2011, Evolent is a fast paced, high… more
- Baylor Scott & White Health (Annapolis, MD)
- …Severity of Illness, and Risk of Mortality. **SALARY - WORK MODEL** 100% Remote The pay range for this position is $37.35 (entry-level qualifications) - $57.89 ... documentation of medical conditions and treatment in patient records. Performs review of record to determine complete, accurate documentation of patient condition… more