- 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)
- …qualifications and comparison with associates in similar roles_ **2 years Utilization Review experience preferred.** **Effective communication with healthcare ... providers, patients, and insurance companies to explain utilization review decisions.** **Familiarity with electronic health records and utilization … 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
- CareFirst (Baltimore, MD)
- …is required in addition to the required work experience. **Licenses/Certifications:** + Health Services\ RN - Registered Nurse - State Licensure and/or ... detail can be shared during the interview process. Plans, organizes, and manages utilization review programs. Directs the utilization of referral services.… more
- CareFirst (Baltimore, MD)
- …experience is required in addition to the required work experience. **Licenses/Certifications:** + RN - Registered Nurse - State Licensure And/or Compact ... **Resp & Qualifications** **PURPOSE:** Utilizing key principles of utilization management, the Utilization Review...Upon Hire Required or + LPN - Licensed Practical Nurse - State Licensure Upon Hire Required + CNS-Clinical… 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
- Ascension Health (Baltimore, MD)
- …Connect with your Talent Advisor for additional specifics._ **Responsibilities** Manage assigned Registered Nurse ( RN ) case managers, related activities and ... including but not limited to: Access Authorization and pre-certification, utilization review and denial management, CareCoordination, Collaborative treatment… more
- Amergis (Baltimore, MD)
- …and referrals for psychosocial needs + Participates in Quality Assurance and Utilization Review activities, as directed + Empowers patients in decision-making ... Amergis Staffing iscurrently seeking experienced Registered Nurses ( RN ) for Case Manager...continuum of care activities forassigned patients and ensuring optimum utilization of resources, servicedelivery, and compliance with medical regime.… more
- Fresenius Medical Center (Columbia, MD)
- **PURPOSE AND SCOPE:** The Inpatient Services Charge Nurse is an additional "responsibility" assigned to the Inpatient Services RN , for a limited period of time, ... duties, as assigned by the Program Manager. The Inpatient Services Charge Nurse ensures appropriate provision of Acute Dialysis Services and treatments within… 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
- 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
- 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
- Veterans Affairs, Veterans Health Administration (Washington, DC)
- …EDRP participants ineligible to apply. Responsibilities The Same Day Procedure Unit (SDPU) Registered Nurse as a licensed professional, will be responsible and ... control precautions appropriate for the Same Day Patient Unit RN . Assigns staff to provide care based on staff...level degree in Nursing may have opportunity to become registered as a nurse with a state… 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
- CareFirst (Baltimore, MD)
- …**Education Level:** High School Diploma or GED. **Licenses/Certifications Upon Hire Required:** + RN - Registered Nurse - State Licensure And/or Compact ... State Licensure RN - Registered Nurse in MD, VA or Washington,...experience working in Care Management, Discharge Coordination, Home Health, Utilization Review , Disease Management or other direct… more
- Evolent (Washington, DC)
- …: * 1-3 years' experience in clinical Appeals Review or Utilization Management Review and is an LPN or RN - Required and Preferred. + Must maintain a ... a mission with a company behind it. **What You'll Be Doing:** The Evolent Appeals Nurse team offers candidates the opportunity to make a meaningful impact as part of… more
- Erickson Living (Silver Spring, MD)
- …of medical practice; insurance benefit structures and related legal/medical issues; and utilization review and quality assurance procedures. Please note that ... consecutive year!_** Join our 5-star rated team as a RN Case Manager (also known as Care Coordinator, Erickson...+ Researches and selects care options as appropriate. The nurse care coordinator may utilize a range of alternative,… more
- Erickson Living (Catonsville, MD)
- …and dehydration. + Participating in Wound Rounds, Operations Meetings, Utilization Review , and Performance Improvement/Risk Management/Safety (PI/RM/S) ... and survey readiness. **What you will need** + Current RN nursing license with no restrictions for the state...3 years' experience in a healthcare leadership role (Charge Nurse , Unit Manager, etc.). + Experience with an electronic… more
- Intermountain Health (Washington, DC)
- …authorization of services based on contractual requirements. + Promptly communicates utilization review needs, days authorized, denials, and other communication ... and retrieves medical records from the Health Information Management for retrospective utilization or quality assurance review . + Delivers routine regulatory… more