- Cognizant (Washington, DC)
- …background - Registered Nurse (RN) + 2-3 years combined clinical and/or utilization management experience with managed health care plan + 3 years' experience ... Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced...care revenue cycle or clinic operations + Experience in utilization management to include Clinical Appeals and… 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
- Immigration and Customs Enforcement (Washington, DC)
- …health facility surveyors and in collaboration with the IHSC Medical Quality Management Unit. SUPERVISORY CONTROLS: The Clinical Senior Nurse Specialist, Medical ... clinical and administrative nursing support, and collaborating with the IHSC Chief Nurse in the Nursing Services Unit to implement initiatives aimed at enhancing… 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
- Ivyhill Technologies LLC (Bethesda, MD)
- …nursing 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
- Evolent (Washington, DC)
- …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
- 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)
- …high-quality care to patients with complex renal needs. As the designated Nurse Supervisor, you'll coordinate staffing, resource management , and clinical ... **Employment Type:** Full time **Shift:** Day Shift **Description:** **Clinical Nurse Supervisor - Dialysis** **Location: Holy Cross Hospital** **Employment Type:… more
- Trinity Health (Silver Spring, MD)
- **Employment Type:** Full time **Shift:** Day Shift **Description:** **Job Title:** Nurse Supervisor- IMC **Employment** **Type:** Full time / Day Shift ... Program + **Location:** Holy Cross Health, Silver Spring, MD **Description:** The Nurse Supervisor is a designated clinical leader for a patient care area… more
- CVS Health (Washington, DC)
- …health outcomes by engaging telephonically with individuals living with diabetes. This nurse will guide members through actionable steps to close gaps in care, ... education, connecting members to resources, and facilitating referrals to care management programs for continued support. This position supports the development and… more
- Evolent (Washington, DC)
- …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and ... **What You Will Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to company policies and… 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 ... exceptional coverage and real savings that make a difference. + **Supportive Leadership** Our management team is here to help you succeed every step of the way. +… 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
- Fresenius Medical Center (Washington, DC)
- …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
- Fresenius Medical Center (Capitol Heights, MD)
- …Classification of Disease (ICD) coding. Manages clinic financials including efficient utilization of supplies or equipment and regular profits and loss review. ... Test. Preferred but not required: 3+ years supervisory or project/program management experience. Med/surg or ICU/CCU experience. PHYSICAL DEMANDS AND WORKING… more
- Ivyhill Technologies LLC (Bethesda, MD)
- …an Associate's Degree and a minimum of 2 years of experience in Utilization Management , Referral Management , Authorization/Denials, or Medical Claims ... Team Ivyhill is currently seeking to hire Referral Management (Non- Nurse ) Reviewers to support its contract with the Integrated Referral Management and… more
- Trinity Health (Silver Spring, MD)
- …protocols. + Demonstrate a high level of patient satisfaction and effective resource utilization . + Collaborate with certified nurse midwives, nurse ... 2 years of supervisory experience. + Demonstrated experience in the development and management of quality, risk, and utilization review processes. + Strong… more
- Select Medical (Alexandria, VA)
- … within the plan of care. + Demonstrates compliance with facility-wide Utilization Management policies and procedures. + Coordinates UR compliance with ... current licensure in a clinical discipline either as a Nurse or a Respiratory Therapist OR Social Work SW/MSW...what is right. The Case Manager is responsible for utilization reviews and resource management , discharge planning,… more
- Select Medical (Alexandria, VA)
- … within the plan of care. + Demonstrates compliance with facility-wide Utilization Management policies and procedures. + Coordinates UR compliance with ... current licensure in a clinical discipline either as a Nurse (RN/LPN/LVN) or a Respiratory Therapist (RT) OR Medical...what is right. The Case Manager is responsible for utilization reviews and resource management , discharge planning,… more
- Erickson Living (Springfield, VA)
- …leadership meetings such as Wound Rounds, Clinical Operations Meeting, Utilization Review, and Performance Improvement/Risk Management /Safety (PI/RM/S) Committee ... by Erickson Senior Living Join our team as the Nurse Manager, RN also known as the Clinical Manager!...and processes in accordance with the Erickson Senior Living Management Policies and Procedures and nursing standards of practice.… more