- 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
- 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 (Washington, DC)
- **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
- Merck (Washington, DC)
- …may include:** + Health care providers such as physicians, physician assistants, nurse practitioners, nurses, pharmacists as well as quality directors and ... at product workshops and conferences, as well as consistent and ongoing review of Company promotional materials. + Providing Company management with updates on… 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 (Washington, DC)
- …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
- Sanofi Group (Washington, DC)
- …franchise is a patient centric organization responsible for delivering the highest quality education and service regarding disease and treatment. The goal of the ... Hematology brands and collaborate with customers on a customized strategy. + Review and analyze market/customer data to support and execute strategic planning. +… more
- Veterans Affairs, Veterans Health Administration (Washington, DC)
- …the absence of the Medical Support Assistant with coordination from the Nurse Manager. Knowledge of anatomy and physiology including location, appearance, and ... by the VHA Education Loan Repayment Services program office after complete review of the EDRP application. Former EDRP Participants are ineligible to apply… more
- Baylor Scott & White Health (Washington, DC)
- …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
- Erickson Living (Silver Spring, MD)
- …practice; insurance benefit structures and related legal/medical issues; and utilization review and quality assurance procedures. Please note that specific ... Village by Erickson Senior Living **This is NOT a remote or hybrid opportunity** **_The Centers for Medicare and...per the team's "care plan". + Reassesses the effectiveness, quality of services, and treatments provided, per health plan… more