- Red River (Chantilly, VA)
- …to lead a portfolio of managed services accounts within the Property Management and Manufacturing verticals. Proven leader who thrives under scrutiny, takes full ... and grow a portfolio of SMB to enterprise-level accounts within Property Management and Manufacturing vertical. . Drive vertical strategy execution, aligning Red… more
- Battelle Memorial Institute (Chantilly, VA)
- …include strategic planning, teaming, capture, requests for proposal (RFP) review , proposal development and submission, contract structure and negotiation, and ... contract management and close-out activities. + Reviews and approves acquisition...on a continuous basis the DCMA Contractor Purchasing System Review (CPSR) and final certification and approval of Battelle's… more
- Somatus (Mclean, VA)
- …Integrity Product Areas:** Clinical Claim Review , Payment Analytics, Fraud Capture, Utilization Review **Product Management ** + **Build** business cases ... our mission. Responsibilities **The Impact** **You'll** **Make:** + **Lead** performance management tied to key metrics and business drivers that inform strategic… more
- Parexel (Washington, DC)
- …mitigations and drive resolution with cross-functional stakeholders as part of the Risk Management Plan. + Review and analyze metrics to derive meaningful ... Leadership:** + Manage and coordinate the integration and utilization of all ancillary systems. + Highlight issues/risks to...project-level resourcing of staff and staff assignments. + Regularly review and update Data Management resources to… more
- Monte Nido (Clifton, VA)
- …may substitute leadership experience elsewhere. + Working knowledge of admissions and intake, Utilization Review , and 3rd party or insurance payers. + Previous ... + Knowledge of Diversity, Equity and Inclusion practices + Employee selection and performance management experience are a plus. + Must hold a Master's degree in a… more
- American Bankers Association (Washington, DC)
- …national significance equals a winning combination! Click Here to review ABA's holistic approach to Benefits and Total Rewards. ... the Chief Finance & Administration Officer (CFAO), shaping financial strategy, risk management , and investment decisions while leading a team of eleven responsible… more
- Battelle Memorial Institute (Arlington, VA)
- …within legal and professional parameters + Knowledge and skill in using pre-established utilization review criteria to recognize and report actual or potential ... by a recognized certifying organization, ie, Commission for Case Management Certification or American Nurse Credentialing Center + At...programs for equal treatment of all staff and full utilization of all qualified employees at all levels within… more
- The Clorox Company (Martinsburg, WV)
- … and change management experience + Ability to train others and review and customize training materials. + Problem-solving mindset: Ability to assess and resolve ... Execution System) Manager is responsible for leading the integration, management , and optimization of the MES at the Martinsburg...and streamline work processes to support effective adoption and utilization of the MES. + Coach and train site… more
- GCG (Washington, DC)
- …Drive change management and user training to ensure effective system utilization across the organization + Monitor system performance and user feedback to ... Business Partners to support talent reviews, succession planning, and performance management , while managing and facilitating key development programs. You will… more
- Battelle Memorial Institute (Arlington, VA)
- …maintaining detailed medical records, possibly supervising trainees, performing case management , and engaging in military-specific training and activities as ... current notes in the electronic medical records of all patients contacted for review by the managing physician + Routinely staff difficult cases with the referring… more
- Battelle Memorial Institute (Crystal City, VA)
- …Gate Reviews are milestones of maturity for business development opportunities. Gate Review Calendar coordination and management requires clear organization of ... to be there. Also includes responsibility for SharePoint administration of Gate Review request portal; logging Gate Review participants; advancing approved… more
- AmeriHealth Caritas (Washington, DC)
- …meet the patient's needs in the least restrictive and most effective manner. The Utilization Management Reviewer must maintain a strong working knowledge of ... **$5,000.00 SIGN ON BONUS** **Role Overview** Our Utilization Management Reviewers evaluate medical necessity...cases are escalated to the Medical Director for further review . The reviewer independently applies medical and… more
- Humana (Washington, DC)
- …**Preferred Qualifications:** + Experience in managed care pharmacy, particularly in utilization management review **Additional Information:** **Interview ... our caring community and help us put health first** The Staff Utilization Management Pharmacist is a clinical expert responsible for conducting medical necessity… more
- Elevance Health (Ashburn, VA)
- …Alternate locations may be considered. The **Medical Director** will be responsible for utilization review case management for North Carolina Medicaid. May ... ** Utilization Management Medical Director- NC Medicaid**...state or territory of the United States when conducting utilization review or an appeals consideration and… more
- CenterWell (Washington, DC)
- …RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability ... Therapy, DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare… more
- Evolent (Washington, DC)
- …Reviewer , Interventional Pain Management , you will be a key member of the utilization management team. We can offer you a meaningful way to make a ... Will Be Doing:** + Serve as the Physician Clinical Reviewer for Interventional Pain Management , reviewing cases... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more
- Evolent (Washington, DC)
- …As a Clinical Reviewer , Nurse, you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... Clinical reviewers are supported by Field Medical Directors (MDs) in the utilization management determination process. + Reviews charts and analyzes clinical… more
- Humana (Washington, DC)
- …. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial ... their daily work. The Medical Director's work includes computer-based review of moderately complex to complex clinical scenarios, ...with prior experience participating in teams focusing on quality management , utilization management , case … more
- Highmark Health (Washington, DC)
- …:** **JOB SUMMARY** This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and ... and DOL regulations at all times. In addition to utilization review , the incumbent participates as the...member of the multidisciplinary team for case and disease management . They will advise the multidisciplinary team on cases,… more
- Evolent (Washington, DC)
- …the mission. Stay for the culture. **What You'll Be Doing:** **Cardiovascular Utilization Management Reviewer (Interventional Cardiologist)** Are you ready ... on patient care in a non-clinical setting? Join our Utilization Management team as a Field Medical... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more
