- Ascension Health (Baltimore, MD)
- …the offer._ **Responsibilities** Provide health care services regarding admissions, case management , discharge planning and utilization review . ... **Details** + **Department:** Utilization Management + **Schedule:** Full-time, Day...and regulations. **Requirements** Licensure / Certification / Registration: + Registered Nurse credentialed from the Maryland Board… more
- Humana (Washington, DC)
- **Become a part of our caring community and help us put health first** The Utilization Management Behavioral Health Nurse 2 utilizes clinical nursing skills ... and communication of behavioral health services and/or benefit administration determinations. The Utilization Management Behavioral Health Nurse 2 work… more
- Trinity Health (Silver Spring, MD)
- …management or related field, with 2+ years in a leadership role in case management , utilization review , or similar areas. + Extensive understanding of ... of hospital staff in inpatient care coordination, social work, utilization review , and discharge planning. + Collaborate...payer mechanisms and clinical utilization management . + Strong interpersonal skills with… more
- Fresenius Medical Center (Baltimore, MD)
- …auditing activities. + Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. + Manages clinic ... financials including efficient utilization of supplies or equipment and regular profits and...of supplies or equipment and regular profits and loss review . + Responsible for all required network reporting and… more
- Ivyhill Technologies LLC (Bethesda, MD)
- …management services for beneficiaries in the Defense Health Network. Registered Nurse will have overall responsibility for timely review of Right of First ... RM Team. Requirements Qualified candidate must be a Licensed Registered Nurse ( RN ), with an...have three (3) years of clinical nursing experience. Referral Management (RM) and Utilization Management … more
- Veterans Affairs, Veterans Health Administration (Baltimore, MD)
- …ineligible to apply. Responsibilities Duties: Home Based Primary Care (HBPC) Outpatient Staff Registered Nurse ( RN ) is responsible for providing competent, ... their care within the HBPC Program. Responsible for case management , assessment, triage, Veteran education, resource coordination, medication and...level degree in Nursing may have opportunity to become registered as a nurse with a state… more
- Humana (Annapolis, MD)
- …and help us put health first** The Compliance Nurse 2 reviews case management and utilization management activities and documentation to ensure adherence ... Quality leadership. **Use your skills to make an impact** **Required Qualifications** + Active Registered Nurse license in the state of Virginia, or obtain a… more
- Trinity Health (Silver Spring, MD)
- …time **Shift:** Day Shift **Description:** **Position Purpose:** As a Case Manager in Utilization Management , you will be the key to ensuring patients receive ... care plans to align with clinical and regulatory standards. By optimizing resource utilization and maintaining the highest standards of care, you will contribute to… more
- System One (Baltimore, MD)
- …and behavioral health. Pay: $47.75/HR Hybrid- Baltimore, MD Must have one of the following: RN - Registered Nurse - State Licensure And/or Compact State ... ALTA IT Services is staffing a contract to hire opportunity for a Utilization Management Specialist to support a leading health insurance customer. The… more
- Ascension Health (Baltimore, MD)
- …and salary range at the time of the offer._ **Responsibilities** Manage assigned Registered Nurse ( RN ) case managers, related activities and workflow ... functions, including but not limited to: Access Authorization and pre-certification, utilization review and denial management , CareCoordination,… more
- Humana (Washington, DC)
- …of our caring community and help us put health first** The Manager, Utilization Management Behavioral Health utilizes behavioral health knowledge and skills to ... of medical services and/or benefit administration determinations. The Manager, Utilization Management Behavioral Health works within specific guidelines… more
- CVS Health (Annapolis, MD)
- …care **Preferred Qualifications** + NICU experience highly preferred + Managed care/ utilization review experience + Ability to multitask, prioritize and ... clinical skills to coordinate, document and communicate all aspects of the utilization /benefit management program. Applies critical thinking and knowledge in… more
- Ivyhill Technologies LLC (Bethesda, MD)
- … Nurse and the the RM Reviewers. Requirements Qualified candidate must be a Licensed Registered Nurse ( RN ), with an unencumbered active RN license ... Ivyhill is currently seeking to hire Referral Management ( RN ) Training Manager to support...have three (3) years of clinical nursing experience. Referral Management (RM) and Utilization Management … more
- CareFirst (Baltimore, MD)
- …5 years medical-surgical or similar clinical experience OR 5 years' experience in Medical Review , Utilization Management or Case Management at CareFirst ... organization or hospital. Demonstrated leadership skills. In Lieu of Education. **Licenses/Certifications:** + RN - Registered Nurse - State Licensure And/or… more
- Amergis (Columbia, MD)
- The Registered Nurse - Hospice Case Manager is responsible for providing care, comfort and support to terminally ill patients. The Registered Nurse - ... delivery of hospice patient care in various settings. The Registered Nurse demonstrates the ability to make...management of patient care. Position Details: + Position: RN Hospice Case Manager (Facility-Based) + Location: Howard County… more
- Erickson Living (Parkville, MD)
- …clinical leadership meetings such as Wound Rounds, Clinical Operations Meeting, Utilization Review , and Performance Improvement/Risk Management /Safety ... and processes in accordance with the Erickson Senior Living Management Policies and Procedures and nursing standards of practice....care, assisted living or hospital) is required. + Current Registered Nurse license for the state in… more
- Sedgwick (Washington, DC)
- …to work. Great Place to Work(R) Most Loved Workplace(R) Forbes Best-in-State Employer RN Medicare Compliance **We are growing and looking for nurses who have their ... clinical data; to complete complex submissions revisions/updates in preparation for Medicare review and act as an internal resource regarding Centers for Medicare &… more
- CareFirst (Baltimore, MD)
- …experience is required in addition to the required work experience. **Licenses/Certifications:** + RN - Registered Nurse - State Licensure And/or Compact ... State Licensure RN - Registered Nurse in MD, VA orWashington, DC...Care Management , Home Health, Discharge Coordination and/or Utilization Review . **Preferred Qualifications:** + Knowledge and… more
- BrightSpring Health Services (Arlington, VA)
- …Education: + Bachelor's Degree in Nursing or the equivalent + Currently licensed as a Registered Nurse ( RN ), in good standing in state of residence ... and direction in performance improvement, provision of clinical services, survey management , documentation management , incident management , EMR/EHR… more
- Sunrise Senior Living (Arlington, VA)
- …of approved college / school of nursing + Maintains a current state license as a Registered Nurse per state regulations. + A minimum of two (2) years' experience ... the highest quality standards for well-being. + Ensures proper utilization of the Resident Care Plan by all team...in a nurse management position within a skilled nursing… more