- Evolent Health (Washington, DC)
- …contractual agreements. **Collaboration Opportunities** : The Coordinator, Intake Utilization Management reports directly to the Manager , Utilization ... the culture. **What You'll Be Doing:** The **Coordinator, Intake Utilization Management ** at Evolent will serve as...medical reviews: LVNs, LPNs, and RNs along with our behavioral health reviewers: LMSWs, LCSW, and LPCs, and Clinical… more
- The Cigna Group (Baltimore, MD)
- …experience required. + Experience in managed care operations and facility network management including behavioral and/or medical with experience with commercial ... The System Contract Senior Manager will have oversight of a region of...developing a performance meeting process which will increase the utilization and expand the number of Facility Center of… more
- CVS Health (Washington, DC)
- …involving clinical issues * Provide leadership and day-to-day physician oversight for utilization management team, including the management of high-risk ... clinical/medical programs * Provide psychiatric leadership to an interdisciplinary utilization management team, including medical/clinical oversight, consultation… more
- Elevance Health (Hanover, MD)
- **Anticipated End Date:** 2024-09-15 **Position Title:** Behavioral Health Medical Director - Child & Adolescent Psychiatry **Job Description:** Wellpoint, formerly ... responsible for appeals reviews within our Medicaid and Medicare programs.** The ** Behavioral Health Medical Director** is responsible for the administration of … more
- CareFirst (Baltimore, MD)
- …the Obstetric specialty. Within that specialty performed the duties of Care Management , Discharge Coordination, Home Health, Utilization Review, Disease ... CCM/ACM or other RN Board Certified certification in case management . Incumbents not certified at the time of hire...patient care experience. See additional information below if Care Manager position is behavioral health focused. **Preferred… more
- CareFirst (Baltimore, MD)
- …supervision, the Care Manager researches and analyzes a member's medical and behavioral health needs and healthcare cost drivers. The Care Manager works ... Required. **Experience** : 5 years clinically related experience working in Care Management , Discharge Coordination, Home Health, Utilization Review, Disease … more
- National Youth Advocate Program (Silver Spring, MD)
- …initiatives including administrative and clinical review of medical records, utilization management , outcome measurement, and generating statistical and ... + Maintain the agencies compliance with HIPAA responsibilities and records management . **MINIMUM QUALIFICATIONS** + Bachelor's degree in behavioral sciences,… more
- Highmark Health (Washington, DC)
- …Inc. **Job Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of health ... depending on where clinical care is being provided. **Preferred** + Certification in utilization management or a related field **SKILLS** + Working knowledge of… more
- Elevance Health (Washington, DC)
- …or other criteria used to determine medical necessity strongly preferred. + Utilization management experience is preferred but not required. + Certification ... - 5:00 PM. Monday through Friday. The **Nurse Case Manager I** is responsible for performing care management...**Preferred Skills, Capabilities, and Experiences:** + Maternal child case management and/or behavioral health case management… more
- Highmark Health (Washington, DC)
- …includes leveraging cutting-edge customer experience platforms, implementing robust data management solutions, and optimizing marketing automation tools to drive ... department. This role will be responsible for managing our MarTech ecosystem, including management and delivery of agreed upon road maps and platform integrations to… more
- Ford Motor Company (Washington, DC)
- …are as smart as you are. The Merchandise eCommerce Merchandising & Product Manager is responsible for deeply understanding customer needs, managing the day-to day ... day by pulling, analyzing, and translating web analytics and behavioral data into actionable insights to enhance sales, conversion,...experience + 3+ years of eCommerce Merchandising AND Product Management experience + 1+ years of Shopify Site … more
- Abt Global Inc. (Rockville, MD)
- …rewarding and meaningful work? Now's your chance. **The Opportunity** The Project Management (PM) Sub Capability Lead reports to the PM Capability Leader within ... the professional development and growth of team members, meeting utilization targets, and collaborating with market teams to identify...Lead is expected to be a highly skilled Project Manager and will be responsible for managing large projects… more
- Highmark Health (Washington, DC)
- …actions (promotions, hiring, terminations, etc.) Develops talent, Addresses resource management , cultivates capabilities of staff, planning and coordination of work, ... in first-line resolution of complex technical problems 2. Provides Staff Management oversight * Hires, promotes, separates or makes recommendations regarding same… more
- Amentum (Arlington, VA)
- …are interested in personnel with technical managerial, and/or financial management experience supporting Government technology development projects, preferably in ... devices, diagnostics, and digital health domains + Software development and management + Electronic Health Record and Cybersecurity, redundant backup system,… more
- M&T Bank (Baltimore, MD)
- …Serves as Bank-wide or industry expert in key area(s) of quantitative risk management . Provides mentoring, training and guidance to less experienced analysts and may ... lead/manage teams on a project basis, providing performance feedback to management as appropriate. **Primary Responsibilities:** + Lead research and development of… more
- Sunrise Senior Living (Mclean, VA)
- …and performance management . * Partner with the Divisional Talent Acquisition Manager for all Executive Directors and Regional team members being considered for ... In addition, providing coaching, development, and mentoring to regional and community level management teams along with Senior HR Managers and working with the Vice… more
- Elevance Health (Arlington, VA)
- …face-to-face clinical assessments for the identification, evaluation, coordination and management of member's needs, including physical health, behavioral ... VA. The **LTSS Service Coordinator RN Clinician** is responsible for overall management of member's case within the scope of licensure; provides supervision and… more
- Elevance Health (Arlington, VA)
- …contract. **Preferred Skills, Knowledge, and Experience:** + Previous experience with Utilization Management preferred. + Computer experience and experience ... RN with telephonic assessments for the identification, evaluation, coordination and management of member's needs, including physical health, behavioral health,… more
- Guardian Life (Washington, DC)
- …certification in profession, such as Certified Rehabilitation Counselor (CRC),Certified Disability Management Specialist (CDMS), Certified Case Manager (CCM). + ... attitude. You can collaborate with stakeholders to provide effective case management within the boundaries of contractual definitions. **You will:** + Assess… more
- CenterWell (Washington, DC)
- …optimal patient care, high quality health outcomes, and improved cost and utilization in pharmacy-related care, and serve as a national clinical program leader ... This role reports to the National Director, High Risk Patient Management . Responsibilities will include: + Lead comprehensive clinical pharmacy service development,… more