- One Medical (Washington, DC)
- …Ongoing collaboration with both virtual and in-office teammates via daily huddles Utilization of your specific clinical training and opportunities to give ... care services, on-site labs, and programs for preventive care, chronic care management , common illnesses and mental health concerns have been delighting people for… more
- Humana (Annapolis, MD)
- …help us put health first** Full-Time, Remote Telephonic opportunity 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
- Humana (Annapolis, MD)
- …of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, ... determination of the appropriate courses of action. The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and independent… more
- CVS Health (Annapolis, MD)
- …And we do it all with heart, each and every day. **Position Summary** Utilization Management is a 24/7 operation and work schedules will include weekends, ... holidays, and evening hours. * Utilizes clinical experience and skills in a collaborative process to...and unrestricted RN licensure in state of residence - Utilization Management is a 24/7 operation and… more
- CenterWell (Annapolis, MD)
- …RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to ... Therapy, DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare… 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...(BSN) preferred + Minimum of 3 years of diverse clinical experience as a Registered Nurse in… more
- CareFirst (Baltimore, MD)
- …programs/plans (all benefits/incentives are subject to eligibility requirements). **Department** Clinical Utilization Management **Equal Employment ... **Resp & Qualifications** **PURPOSE** : Supervise the daily operations of the utilization management (UM) department functions to ensure appropriate coordination… more
- Immigration and Customs Enforcement (Washington, DC)
- …with the IHSC Medical Quality Management Unit. SUPERVISORY CONTROLS: The Clinical Senior Nurse Specialist, Medical Asset Support Team (MAST) member works ... of complex tasks requiring developed proficiency/ higher responsibility: serving as Clinical Coordinator/ Acting Nurse Manager/ Acting Regional Nurse… more
- Evolent (Annapolis, MD)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. ... physician-developed medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care… more
- BAYADA Home Health Care (Towson, MD)
- …/ Towson, MD** **_._** Are you a solutions-oriented, team-focused **Registered Nurse , Licensed Practical Nurse or Therapist (Physical Therapist, Occupational ... create alignment to common goals across multiple levels of management ? Would you like to be viewed as a...members to deliver on our differentiated offerings. Through the utilization of outcome driven data analytics, this role will… more
- Fresenius Medical Center (Towson, MD)
- **About this role:** As a Clinical Manager with Fresenius Medical Care, you will ensure that quality patient care is delivered while maintaining clinical ... or chronic kidney disease. **Training and advancement:** You will enter our Clinical Leadership Program that creates and supports a culture of continuous learning… more
- Veterans Affairs, Veterans Health Administration (Washington, DC)
- …to patient groups, maximizing utilization of resources, and enhancing the case management program. The nurse 's primary commitment is to the patient, whether ... Summary The Psychosocial Rehabilitation and Recovery Center Nurse role is to collaboratively manage, coordinate and...care, and minimizing health care costs. Responsibility includes the utilization of general clinical nursing skills and… more
- Johns Hopkins University (Baltimore, MD)
- …guidelines of the department and institution and in accordance with the Nurse Practitioner-Physician Written Agreement required and approved by the State of Maryland ... and the Nurse Practice Act of the State of Maryland. Is...long-term effects of radiation and provides accurate and timely management for such side effects. + Provides education to… 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 ... ** Nurse Reviewer I** **Virtual:** This role enables associates...required. **Preferred Skills, Capabilities, and Experiences:** + Familiarity with Utilization Management Guidelines, ICD-9 and CPT-4 coding,… more
- CVS Health (Annapolis, MD)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... self-insured clients. + Application and/or interpretation of applicable criteria and clinical guidelines, standardized care management plans, polices, procedures… more
- Johns Hopkins University (Baltimore, MD)
- …to obtain informed consent from study participants. + Remain proficient in the utilization of commonly used clinical protocols and guidelines. + Remain abreast ... The Department of Emergency Medicine is seeking a **_Sr. Nurse Practitioner_** to work collaboratively within a multidisciplinary health care team. Responsible for… more
- Veterans Affairs, Veterans Health Administration (Washington, DC)
- …and analysis for the purpose of improving care to patient groups, maximizing utilization of resources and enhancing the case management program. Adhere to ... Summary The Intensive Community Mental Health Program (ICMHR) Registered Nurse (RN) is a member of the Behavioral Health Care Service Line whose role is to… 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 ... complex patients in the assigned area. The incumbent demonstrates clinical competence in the assessing, planning, implementing, coordinating, monitoring, evaluating… more
- Johns Hopkins University (Baltimore, MD)
- …to obtain informed consent from study participants. + Remain proficient in the utilization of commonly used clinical protocols and guidelines. + Remain abreast ... to plan patient care. + Responsible for the conduct of EM sponsored clinical trials including regulatory issues, recruitment and good clinical practice.… more
- Johns Hopkins University (Baltimore, MD)
- …to obtain informed consent from study participants. + Remain proficient in the utilization of commonly used clinical protocols and guidelines. + Remain abreast ... The Department of Emergency Medicine is seeking a **_Sr. Nurse Practitioner_** to work collaboratively within a multidisciplinary health care team. Responsible for… more
