- Humana (Annapolis, MD)
- …community and help us put health first** Full-Time, Remote Telephonic opportunity The Utilization Management Nurse 2 utilizes clinical nursing skills to ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...appropriate courses of action. As a Utilization Management RN working on the OneHome/ Home Solutions… more
- CenterWell (Annapolis, MD)
- …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
- Humana (Annapolis, MD)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE** : Supervise the daily operations of the utilization management (UM) department functions to ensure appropriate coordination ... expected to work a portion of their week from home and a portion of their week at a...business. **Knowledge, Skills and Abilities (KSAs)** + Oversight of Utilization Management clinicians while championing process improvement,… more
- Veterans Affairs, Veterans Health Administration (Baltimore, MD)
- …utilization . Demonstrates leadership in delivering and improving holistic, home -based care through collaborative strategies with others. - Critical-Thinking ... Health in an environment that supports personalized and proactive care. Responsibilities Home Based Primary Care (HBPC) Patient Aligned Care Team (PACT) Staff… more
- Trinity Health (Silver Spring, MD)
- …MD Area** **Position Overview - Day 1 Benefits, 10k Sign-on Bonus & More** As a Home Health Registered Nurse , you'll provide in- home skilled nursing care to ... **Employment Type:** Full time **Shift:** **Description:** **Holy Cross Home Care Team is looking for a Fu**...savings that make a difference. + **Supportive Leadership** Our management team is here to help you succeed every… more
- BAYADA Home Health Care (Towson, MD)
- **BAYADA Senior Living Solutions** , a specialty offering of BAYADA Home Health Care, was created to address the unique needs of senior living communities, and their ... Towson, MD** **_._** Are you a solutions-oriented, team-focused **Registered Nurse , Licensed Practical Nurse or Therapist (Physical...create alignment to common goals across multiple levels of management ? Would you like to be viewed as a… more
- Johns Hopkins University (Baltimore, MD)
- …guidelines of the department and institution and in accordance with the Nurse Practitioner-Physician Written Agreement required and approved by the State of Maryland ... and the Nurse Practice Act of the State of Maryland. Is...long-term effects of radiation and provides accurate and timely management for such side effects. + Provides education to… more
- Evolent (Annapolis, MD)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Nurse Reviewer is responsible for performing precertification and prior approvals. Tasks are ... quality and cost effective care delivery. **What You'll Be Doing:** + Performs utilization review of outpatient procedures and ancillary services. + Fulfills on call… more
- Trinity Health (Silver Spring, MD)
- …high-quality care to patients with complex renal needs. As the designated Nurse Supervisor, you'll coordinate staffing, resource management , and clinical ... **Employment Type:** Full time **Shift:** Day Shift **Description:** **Clinical Nurse Supervisor - Dialysis** **Location: Holy Cross Hospital** **Employment Type:… more
- Fresenius Medical Center (Annapolis, MD)
- …Quality, and Technical Services departments. + Collaborates with or functions as the Home Therapies Program Manager to oversee the facility's Home Therapies ... Classification of Disease (ICD) coding. + Manages clinic financials including efficient utilization of supplies or equipment and regular profits and loss review. +… more
- CareFirst (Baltimore, MD)
- … - State Licensure and/or Compact State Licensure. **Experience:** 3 years Care Management , Discharge Coordination, Home Health, Utilization Review, Disease ... County/Washington DC or Northern Virginia metropolitan area.** **PURPOSE:** The Inpatient Management Care Management Supervisor will direct and coordinate the… more
- CareFirst (Baltimore, MD)
- …years clinically related experience working in Care Management , Home Health, Discharge Coordination and/or Utilization Review. **Preferred Qualifications:** ... the timely and smooth transition from inpatient care to home or other levels of care. Utilizing experience and...of care. Utilizing experience and skills in both care management and utilization management , the… more
- CareFirst (Baltimore, MD)
- …medical-surgical or similar clinical experience OR 5 years experience in Medical Review, Utilization Management or Case Management at CareFirst BlueCross ... expected to work a portion of their week from home and a portion of their week at a...regulatory and accreditation requirements, understanding of appeals process and utilization management , and systems software used in… more
- Sharecare (Annapolis, MD)
- …/ new hire plan selection, claims issues, ID card issues, grievances/appeals, utilization management (UM) status, including but not limited to medical, ... + Claims adjustments + Grievances and appeals submissions + Utilization management intake or status + Complex...and second opinion. + Referring members to Clinical Advocates ( Nurse ) for conditions that require clinical care and case… more
- CareFirst (Baltimore, MD)
- …hire preferred. **Experience:** 5 years clinically related experience working in Care Management , Discharge Coordination, Home Health, Utilization Review, ... School Diploma or GED **Licenses/Certifications:** + RN - Registered Nurse - State Licensure And/or Compact State Licensure RN-...CCM/ACM or other RN Board Certified certification in case management . Incumbents not certified at the time of hire… more
- Insight Global (Elkton, MD)
- …IP phones. Support and provide technical guidance to the Field Staff. Support of the Nurse Call backend systems. This is an ONSITE position based in Elkton, MD. This ... individual can work from home and have flexibility but must be close-by for...request. 2. Analyzes system traffic reports as requested by management , including operator statistics, voice mail, ACD, trunk, and… more