- Ascension Health (Baltimore, MD)
- …Provide health care services regarding admissions, case management, discharge planning and utilization review . Responsibilities: + Review admissions and ... planning needs with healthcare team members. + May prepare statistical analysis and utilization review reports as necessary. + Oversee and coordinate compliance… 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
- Humana (Annapolis, MD)
- …an impact** **Required Qualifications** **Must meet one of the following:** + Active unrestricted registered nurse license in the state of Virginia or obtain a ... problem-solving skills, facilitation skills **Preferred Qualifications** + Experience with utilization review process + Experience with behavioral change,… 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
- 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)
- …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
- 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
- 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, ... equivalent to a bachelor's level degree in Nursing may have opportunity to become registered as a nurse with a state licensing board prior to completion… more
- Humana (Annapolis, MD)
- …guidelines/procedures. **Use your skills to make an impact** **Required Qualifications** + Active Licensed Registered Nurse ( RN ) in the state of Virginia or ... of our caring community and help us put health first** The Pre-Authorization Nurse 2 reviews prior authorization requests for appropriate care and setting, following… 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
- Evolent (Annapolis, MD)
- …+ Performs other duties as assigned. **Qualifications: Required and Preferred:** + Licensed registered nurse or LVN/LPN (current and unrestricted) + Minimum of ... direct clinical patient care + **Minimum one year of experience with Utilization Review (UM) in a managed care environment** + Cardiology and Oncology Healthcare… more
- Highmark Health (Annapolis, MD)
- …+ Experience in UM/CM/QA/Managed Care **LICENSES or CERTIFICATIONS** **Required** + United States Registered Nurse ( RN ) license + Delaware RN ... Health **Job Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of health… more
- Trinity Health (Silver Spring, MD)
- …**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
- CareFirst (Baltimore, MD)
- …treatment needs or those with substance disorders and addictions. **Licenses/Certifications** : + RN - Registered Nurse - State Licensure And/or Compact ... psychiatric setting. **Preferred Qualifications** : + 2 years experience in Medical Review , Utilization Management or Case Management at CareFirst BlueCross… more
- CareFirst (Baltimore, MD)
- …organization or hospital. Demonstrated leadership skills. In Lieu of Education. **Licenses/Certifications:** + RN - Registered Nurse - State Licensure And/or ... similar clinical experience OR 5 years' experience in Medical Review , Utilization Management or Case Management at...Case Manager Upon Hire Preferred + LNCC - Legal Nurse Consultant Certified Upon Hire Preferred **Preferred Qualifications:** +… more
- Humana (Annapolis, MD)
- …**Required Qualifications:** **Must meet** **one** **of the following:** + Active unrestricted registered nurse license in the state of Virginia or reside ... case manager required. **Additional Information:** **Workstyle:** Remote work at Home **Location for Registered Nurse :** must reside in the state of Virginia or… 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
- 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
- Sedgwick (Annapolis, MD)
- …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
- Johns Hopkins University (Baltimore, MD)
- …fluids with blood borne pathogens. **Minimum Qualifications** + Master's Degree in Nursing. + Registered Nurse license and Certified as a Nurse Practitioner. ... support in response to emergency situations. + Prepare chart documentation for review and counter signature by the physician. + Determine differential diagnosis. +… more