- The Arora Group (Bethesda, MD)
- …+ The Contractor shall frequently collaborate with managers of the UBO, Utilization Review Registered Nurse ( RN ) and pre-certification clerk. + The ... Licensed Practical Nurse (LPN) - Utilization Review Nurse Currently...or emergent patient care situations, seek assistance of the RN and/or MD/DO, and initiate appropriate emergency interventions as… more
- Ascension Health (Baltimore, MD)
- …experience, location, qualifications and comparison with associates in similar roles_ ** Registered Nurse , Certified Case Manager (CCM, ACM, URAC) preferred ... salary range at the time of the offer._ **Responsibilities** Manage effective utilization review processes, including management of patient statusing processes… more
- Humana (Annapolis, MD)
- …guidelines/procedures **Use your skills to make an impact** **Required Qualifications** + Licensed Registered Nurse ( RN ) with no disciplinary action in the ... put health first** Humana Healthy Horizons in Ohio is seeking a Utilization Management Nurse 2 who utilizes clinical nursing skills to support the coordination,… more
- CareFirst (Baltimore, MD)
- …care, and experience reviewing patient medical care Demonstrated leadership skills. **Licenses/Certifications** RN - Registered Nurse - State Licensure ... standards and federal/state regulations and general principles relating to utilization review .Computer skills, including Microsoft Office programs. +… more
- CareFirst (Baltimore, MD)
- …management, discharge planning or utilization review experience. **Licenses/Certifications** RN - Registered Nurse - State Licensure And/or Compact ... **Resp & Qualifications** **PURPOSE:** The Clinical Medical Review Nurse handles day to day review of professional and institutional claims and provider… more
- Erickson Living (Parkville, MD)
- …leadership meetings such as Wound Rounds, Clinical Operations Meeting, Utilization Review , and Performance Improvement/Risk Management/Safety (PI/RM/S) Committee ... (skilled nursing, long term care, assisted living or hospital) is required. + Current Registered Nurse license for the state in which they operate. + Current… 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 ... including but not limited to: Access Authorization and pre-certification, utilization review and denial management, CareCoordination, Collaborative treatment… more
- Trinity Health (Silver Spring, MD)
- …the activities of hospital staff in inpatient care coordination, social work, utilization review , and discharge planning. + Collaborate with the Medical ... field (nursing, social work, healthcare administration, or medicine). + RN with active preference Maryland license highly preferred. +...2+ years in a leadership role in case management, utilization review , or similar areas. + Extensive… 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)
- …referral management services for beneficiaries in the Defense Health Network. Registered Nurse will have overall responsibility for timely review of Right of ... of Specialty Care Referrals, sustaining up-to-date Specialty Clinic Referral Review tools and booking guidance, complying with Referral and...RM Team. Requirements Qualified candidate must be a Licensed Registered Nurse ( RN ), with an… more
- The Cigna Group (Baltimore, MD)
- The RN Coordinator serves as the key contact point for...as needed 3) 3+ years of experience as a Registered Nurse 4) Proficient level of experience with ... and make specific recommendations based on their goals 4. Review paperwork for patients to ensure it meets all...of the team to manage heath care cost and utilization **Provider Support** 1. Completes telephonic nursing assessments including… more
- CareFirst (Baltimore, MD)
- …people. **QUAIFICATIONS:** **Education Level:** High School Diploma or GED. **Licenses/Certifications:** + RN - Registered Nurse - State Licensure And/or ... **Resp & Qualifications** **PURPOSE:** The Clinical Appeals Supervisor ( RN ) directs and coordinates the accurate implementation of...clinical experience OR + 5 years experience in Medical Review , Utilization Management or Case Management at… 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...working in Care Management, Home Health, Discharge Coordination and/or Utilization Review . **Preferred Qualifications:** + Knowledge and… more
- Highmark Health (Annapolis, MD)
- …Sunday required in addition to 3 weekdays** This job implements effective utilization management strategies including: review of appropriateness of health care ... services, application of criteria to ensure appropriate resource utilization , identification of opportunities for referral to a Health Coach/case management, and… more
- Amergis (Columbia, MD)
- The Registered Nurse - Hospice Case Manager is responsible for providing care, comfort and supportto terminally ill patients. The Registered Nurse - ... and accountability for the delivery of hospice patient carein various settings. The Registered Nurse demonstrates the abilityto make clinical judgments in an… 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 its contract with...all incoming RM staff to be able to accurately review referrals utilizing the Specialty Referral Guideline (SRG) compliance… more
- Intermountain Health (Annapolis, MD)
- …REGISTRATION, LICENSE (*indicates primary source verification requirement) Required: + Active Registered Nurse License Preferred: + Certified Healthcare Access ... **Job Description:** The Pre-Access Prior Authorization RN provides timely review of authorization...Associate (CHAA) EXPERIENCE Required: + Licensed Registered Nurse + Minimum of 2 years'… more
- CareFirst (Baltimore, MD)
- …experience is required in addition to the required work experience. **Licenses/Certifications:** + RN - Registered Nurse - State Licensure And/or Compact ... with dynamic goals resulting in the full and fair review of appeals and designed to achieve corporate objectives...+ Master's in Science Nursing or related field, Legal Nurse Consultant, Utilization Management, and Government Program… more
- Guardian Life (Annapolis, MD)
- **Position Summary** The RN Clinical Consultant serves as a clinical resource for the investigation and assessment of medical information regarding disability by ... medical reviews and analysis of long-term disability claims. The RN Clinical Consultant identifies restrictions, limitations and duration impacting functional… more
- BrightSpring Health Services (Baltimore, MD)
- …Education: + Bachelor's Degree in Nursing or the equivalent + Currently licensed as a Registered Nurse ( RN ), in good standing in state of residence ... ensuring field clinical staff meet daily/weekly/monthly/quarterly and annual requirements + Review 's incident report trends - ensures follow up as needed. Conducts… more