- Greenspring Village by Erickson Senior Living (Springfield, VA)
- …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
- Greenspring Village by Erickson Senior Living (Springfield, VA)
- …weight loss, and dehydration. Participating in Wound Rounds, Operations Meetings, Utilization Review , and Performance Improvement/Risk Management /Safety ... (PI/RM/S) Committee. Reviewing clinical outcomes to ensure that we stay above the National, State, and Erickson benchmarking thresholds. Collaborating with DON to plan, develop and maintain the clinical operational budget for the nursing department. Partnering… more
- Foxhole Technology (Washington, DC)
- Overview Position: Software Product Management Lead Location: Washington DC (Hybrid) Clearance: Secret Start: Based on contract award Foxhole Technology provides ... . Foxhole Technology is seeking an experienced Subject Matter Expert Software Production Management Lead as part of a team of information assurance professionals in… 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
- 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
- Evolent (Washington, DC)
- …Doing:** As a Cardiology, Field Medical Director you will be a key member of the utilization management team. We can offer you a meaningful way to make a ... utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality… more
- Evolent (Washington, DC)
- …As a Vascular Surgery, Field Medical Director you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality… more
- Capital One (Mclean, VA)
- …onboard their products/services and support them in ramping up to full utilization . Treasury Management Associates regularly identify opportunities to improve ... Senior Associate, Treasury Management Associate Aligned to one or more Commercial...pricing proformas, proposal documentation and provides inputs into sales/relationship review presentations + Assist with client acquisition and deepening… more
- Evolent (Washington, DC)
- …Doing:** As a Field Medical Director, Oncology, you will be a key member of the utilization management team. We can offer you a meaningful way to make a ... utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality… more
- Evolent (Washington, DC)
- …Doing:** Job Description As a FMD, Radiology you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality… more
- RxBenefits (Washington, DC)
- …channel management , B/G classifications, specialty designations, rebate eligibility, utilization trend, Utilization Management (UM) implications, ... prospect member size, marketing agreements, broker commissions, and drug utilization . + Be the SME on dozens of medical...closed won groups into a client record for Account Management (AM) and Implementation including the initial gathering of… more
- Elevance Health (Washington, DC)
- …and experience, which would provide an equivalent background. **Preferred Qualifications** + Utilization review / utilization management experience is a ... Medical Management team by managing and overseeing non-clinical medical management specialists to ensure utilization regulatory compliance and member service… more
- Amazon (Herndon, VA)
- …and develop mitigation strategies to keep projects on track * Work with the Power Utilization Management and Planning (PUMP) team and the CDP AMER Power Projects ... talented Regional Power Programs TIPM to drive improvements in existing data center utilization across the US-West region. You will have goals to reclaim stranded… more
- Evolent (Washington, DC)
- …quality and cost effective care delivery. **What You'll Be Doing:** + Performs utilization review of outpatient procedures and ancillary services. + Fulfills on ... mission. Stay for the culture. **What You'll Be Doing:** The Nurse Reviewer is responsible for performing precertification and prior approvals. Tasks are performed… more
