- Humana (Annapolis, MD)
- …documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are ... a part of our caring community and help us put health first** The Utilization Management Registered Nurse 2 utilizes clinical nursing skills to support the… more
- Trinity Health (Silver Spring, MD)
- …the activities of RN Case Managers for in inpatient care coordination and utilization review . Oversees interactions of staff with outside activities and agencies ... required. + Extensive knowledge of payer mechanisms and clinical utilization management is required **Preferred:** + At...in an acute healthcare setting. + Designation Changes and Utilization Review + Knowledge of pertinent regulatory,… more
- Lincoln Financial Group (Washington, DC)
- …Experience and/or proficiency with Disability Management (STD/LTD) knowledge, Workers Compensation, Utilization Review and/or nurse case management ... Role at a Glance** We are excited to bring on a highly motivated Nurse Disability Consultant to our clinical organization. This position will be responsible for… more
- CareFirst (Baltimore, MD)
- …Licensure Upon Hire Required. **Experience:** 8 years' Experience in a clinical and utilization review role. 3 years Management experience. **Preferred ... based on business needs and work activities/deliverables that week. The Director, Utilization Management provides strategic leadership of the utilization … more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** Supervise the daily operations of the utilization management (UM) department functions to ensure appropriate coordination ... accreditation standards and federal/state regulations and general principles relating to utilization review . + Computer skills, including Microsoft Office… more
- Elevance Health (Hanover, MD)
- …equivalent and a minimum of 3 years acute care clinical experience or case management , utilization management or managed care experience; or any combination ... payment. May also manage appeals for services denied ,** **continued stay review , care coordination, and discharge planning for appropriateness of treatment setting… more
- Johns Hopkins University (Washington, DC)
- …support in response to emergency situations. + Prepare chart documentation for review and counter signature by the physician. + Determine differential diagnosis. + ... to obtain informed consent from study participants. + Remain proficient in the utilization of commonly used clinical protocols and guidelines. + Remain abreast of… more
- Prime Therapeutics (Washington, DC)
- …of post-degree clinical experience. + Experience in managed care, specialty drugs, care management and utilization review . + Meets Magellan Credentialing ... and drives every decision we make. **Job Posting Title** Infusion Referral Nurse - REMOTE **Job Description Summary** Under supervision, is responsible for performing… more
- Elevance Health (Hanover, MD)
- …**Minimum requirements:** + Requires minimum of 3 years acute care clinical experience, utilization management or managed care experience; or any combination of ... ** Nurse Medical Management Sr.** **Location:** **multiple...May also manage appeals for services denied. + Stay review , care coordination, and discharge planning for appropriateness of… more
- Elevance Health (Woodlawn, MD)
- …requirements:** + Requires minimum of 3 years acute care clinical experience or case management , utilization management or managed care experience; or any ... ** Nurse Medical Management II** **Location: multiple...appeals for services denied. + Conducts precertification, continued stay review , care coordination, or discharge planning for appropriateness of… 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
- Sedgwick (Washington, DC)
- …and consult review ; and two (2) years of experience in daily application of nurse auditing, utilization review and bill review . **Skills & ... Great Place to Work(R) Most Loved Workplace(R) Forbes Best-in-State Employer RN Bill Review **PRIMARY PURPOSE** **:** To review hospital and professional medical… more
- Trinity Health (Silver Spring, MD)
- … initiatives. Completes comprehensive assessment of patient situations utilizing Case Management documentation standards, review of medical record, collaboration ... position requires a minimum of two years of experience in Social Work Case Management within an acute care facility. Additional training to learn the role will not… more
- CenterWell (Annapolis, MD)
- …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and ... requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking...and reliable transportation. + Two years as a Registered Nurse with at least one-year of management … more
- Highmark Health (Washington, DC)
- …Inc. **Job Description :** **JOB SUMMARY** This job implements the effective utilization management strategies including: review of appropriateness of ... and offers interventions and/or alternatives. **ESSENTIAL RESPONSIBILITIES:** + Implement care management review processes that are consistent with established… more
- CareFirst (Baltimore, MD)
- …performed the duties of Care Management , Discharge Coordination, Home Health, Utilization Review , Disease Management and/or other direct patient care ... **Resp & Qualifications** **PURPOSE:** Under minimal supervision, the Obstetric Nurse Care Manager researches and analyzes an Obstetric member's medical and… more
- CareFirst (Baltimore, MD)
- …working in Care Management , Home Health, Discharge Coordination and/or Utilization Review . **Preferred Qualifications:** + Knowledge and experience with ... of care utilizing experience and skills in both case management and utilization management . This...to discharge. We are looking for an experienced Registered Nurse with NICU and pediatric experience living within the… more
- Ascension Health (Baltimore, MD)
- …functions, including but not limited to: Access Authorization and pre-certification, utilization review and denial management , CareCoordination, ... specialist for staff in the areas of utilization criteria, appeal and review process, and case management system documentation. + Develop staff schedule and… more
- Erickson Living (Parkville, MD)
- …clinical leadership meetings such as Wound Rounds, Clinical Operations Meeting, Utilization Review , and Performance Improvement/Risk Management /Safety ... clinical practice and processes in accordance with the Erickson Senior Living Management Policies and Procedures and nursing standards of practice. + Ownership of… more
- Elevance Health (Hanover, MD)
- …**How you will make an impact:** + Develops, maintains and enhances the claims review process. + Assists management with developing unit goals, policies and ... responsible for identifying, monitoring, and analyzing aberrant patterns of utilization and/or fraudulent activities by health care providers through prepayment… more