- Elevance Health (Washington, DC)
- The Nurse Medical Mgmt I is responsible to collaborate with healthcare providers and members to promote quality member outcomes, to optimize member benefits, and to ... promote effective use of resources. Ensures medically appropriate, high quality, cost effective care through assessing the medical necessity of inpatient admissions, outpatient services, focused surgical and diagnostic procedures, out of network services, and… more
- Evolent Health (Washington, DC)
- …day to day direction, expert operational and system knowledge and operational guidance to nurse staff in the UM department. + In collaboration with the Manager ... driving results, and collaborating with others. **Collaboration Opportunities** : The Lead Nurse of Utilization Management is responsible for assisting the UM … more
- Somatus (Mclean, VA)
- …mission, values, and policies of Somatus + Assist Directors of Quality and UM on quality and utilization audits as assigned, including targeted audits as requested ... experience in dialysis or renal care setting is a must. * Current Registered Nurse compact state licensure and other states as deemed necessary by state law or… more
- Sharecare, Inc. (Washington, DC)
- …hire plan selection, claims issues, ID card issues, grievances/appeals, utilization management ( UM ) status, including but not limited to medical, dental, and vision ... for care management and second opinion. + Referring members to Clinical Advocates ( Nurse ) for conditions that require clinical care and case management assistance +… more