- Elevance Health (Washington, DC)
- The Utilization Management Nurse is responsible to collaborate with healthcare providers and members to promote quality member outcomes, to optimize member ... and minimum of 2 years acute care clinical experience. + Minimum 1 year Utilization Management experience preferred. For candidates working in person or remotely… more
- CareFirst (Baltimore, MD)
- …based on business needs and work activities/deliverables that week. The Director, Utilization Management provides strategic leadership of the utilization ... and is responsible for the design, assessment, implementation and outcomes of utilization management strategies using a multidisciplinary approach to enhance… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** Utilizing key principles of utilization management , the Utilization Review Specialist will perform prospective, ... coverage. Leveraging clinical expertise and critical thinking skills, the Utilization Review Specialist, will analyze clinical information, contracts, mandates,… more
- Evolent (Washington, DC)
- …the mission. Stay for the culture. **What You'll Be Doing:** The **Coordinator, Intake Utilization Management ** at Evolent will serve as a point of contact for ... and client contractual agreements. **Collaboration Opportunities** : The Coordinator, Intake Utilization Management reports directly to the Manager, Intake … more
- Ascension Health (Baltimore, MD)
- **Details** + **Department:** Utilization Management + **Schedule:** Monday-Friday, 8:00AM-4:30PM. May involve occasional evening and weekend shifts. May have an ... on-call rotation for weekends or holidays, responsible for addressing urgent utilization management cases that arise during those times. + **Hospital:**… more
- Johns Hopkins University (Lutherville, MD)
- The Department of Otolaryngology is seeking a **_CO_** **_Clinical Nurse Manager_** the Clinical Nurse Manager collaborates with the Medical Director and Clinic ... staff training/ education and development. In partnership with the Clinic Supervisor, the Nurse Manager provides oversight to the clinical staff (RNs/ CMAs) in three… more
- Johns Hopkins University (Baltimore, MD)
- …The Research Nurse Manager will be responsible for the overall management of the clinical trials portfolio and clinical research activities within the UAD ... We are seeking a **_CO_** **_Research Nurse Manager_** to work under the Director of...and regulatory specialists), developing and implementing effective clinical trials management strategies including data management and regulatory… more
- Veterans Affairs, Veterans Health Administration (Washington, DC)
- …knowledge of the internal referral care process, clinical review criteria, utilization management standards, clinical documentation requirements, community care ... by education and experience to apply advanced clinical practice and case management principles for the coordination and oversight of healthcare provided to Veterans… more
- CareFirst (Baltimore, MD)
- …standards and assisting with department training. Collaborates with other business units: Utilization Management , Case Management , Claims, Quality ... Management and Compliance. The Nurse , Quality Review position develops procedures and reinforce quality...+ Clinical appeals and grievance experience with government programs, Utilization Management , + Managed Care experience, Experience… more
- CareFirst (Baltimore, MD)
- …psychiatric setting. **Preferred Qualifications:** + 2 years' experience in Medical Review, Utilization Management or Case Management at CareFirst BlueCross ... of regulatory and accreditation requirements, understanding of appeals process and utilization management , and systems software used in processing appeals.… more
- Trinity Health (Silver Spring, MD)
- …and patients often require cardiac telemetry monitoring and/or mechanical ventilator support. The Nurse in Charge (NIC) is a designated clinical leader for a patient ... and accountable for: + Cost effective decision-making regarding operations including utilization and application of resources. (ie, human resources, patient care… more
- Johns Hopkins University (Baltimore, MD)
- The Department of Surgery, Bayview Campus is seeking a **_CO Nurse Practitioner_** (Mid-Level Provider - MLP) to work collaboratively within a multidisciplinary ... limited to the following advance procedures, wound care and management , suture and staple removal; phlebotomy, IV placement, removal...4, 5 drugs under the guidelines of the Maryland Nurse Practice Act and the DEA. _Research Coordination_ +… more
- Trinity Health (Germantown, MD)
- …Full time **Shift:** 12 Hour Night Shift **Description:** **Job Title:** Nurse In Charge/ Nurse Supervisor **Unit:** Emergency Department **Employment Type:** ... + **Advancement:** Opportunities to advance within the organization **Description:** The Nurse in Charge (NIC)/ Nurse Supervisor is a designated clinical… more
- Ivyhill Technologies LLC (Bethesda, MD)
- …nursing program. Must have three (3) years of clinical nursing experience. Referral Management (RM) and Utilization Management (UM) experience is preferred. ... Ivyhill is currently seeking to hire a Registered Nurse (Non-Practicing) to support its contract with the Integrated Referral Management and Appointing Center… more
- Trinity Health (Silver Spring, MD)
- **Employment Type:** Part time **Shift:** Weekend Shift **Description:** **Job Title:** Nurse In Charge position for the Operating Room **Employment Type:** ... Advancement Program + **Location:** Holy Cross Health, Silver Spring, MD **Description:** The Nurse in Charge (NIC) is a designated clinical leader for a patient… more
- Erickson Living (Silver Spring, MD)
- Location: Riderwood Village by Erickson Senior Living The Nurse Practitioner, Employee Health and Well-Being, under general supervision from the National Medical ... health, provides high quality, efficient and cost-effective acute care, injury management , community outbreak management , new hire assessments, immunizations,… more
- Trinity Health (Silver Spring, MD)
- …and patients often require cardiac telemetry monitoring and/or mechanical ventilator support. The Nurse in Charge (NIC) is a designated clinical leader for a patient ... and accountable for: + Cost effective decision-making regarding operations including utilization and application of resources. (ie, human resources, patient care… more
- Koniag Government Services (Camp Springs, MD)
- …Koniag Government Services company, is seeking a full time Occupational Health Registered Nurse to support **KPS** and our government customer in Camp Springs, MD. ... provided. + Prepare and submit required reports, including quarterly and annual utilization reports + Manage and maintain medical equipment and supplies + Provide… more
- CareFirst (Baltimore, MD)
- …leadership experience. + Master's in Science Nursing or related field, Legal Nurse Consultant, Utilization Management , and Government Program experience ... of regulatory and accreditation requirements, understanding of appeals process and utilization management , and systems software used in processing appeals.… more
- The Cigna Group (Baltimore, MD)
- …education including possible side effects, plan of care, and individualized care goals management in a culturally sensitive and acceptable manner for the patient or ... works as part of the team to manage heath care cost and utilization **Provider Support** 1. Completes telephonic nursing assessments including social determinants of… more