- Trinity Health (Silver Spring, MD)
- …management or related field, with 2+ years in a leadership role in case management , utilization review , or similar areas. + Extensive understanding of ... of hospital staff in inpatient care coordination, social work, utilization review , and discharge planning. + Collaborate...payer mechanisms and clinical utilization management . + Strong interpersonal skills with… more
- Fresenius Medical Center (Clinton, MD)
- …and acts as the liaison for patient care as per the disease management agreement, including initial and ongoing validation of member eligibility. Facilitate timely ... workup of patients for access management , dialysis services, patient education, hospitalizations, and kidney transplantation as appropriate, and ensures coordination… more
- Ivyhill Technologies LLC (Bethesda, MD)
- …management services for beneficiaries in the Defense Health Network. Registered Nurse will have overall responsibility for timely review of Right of First ... RM Team. Requirements Qualified candidate must be a Licensed Registered Nurse ( RN ), with an...have three (3) years of clinical nursing experience. Referral Management (RM) and Utilization Management … more
- Highmark Health (Washington, DC)
- …Highmark Health **Job Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of ... + Experience in UM/CM/QA/Managed Care **LICENSES or CERTIFICATIONS** **Required** + United States Registered Nurse ( RN ) license + Delaware RN … more
- Humana (Washington, DC)
- …guidelines/procedures. **Use your skills to make an impact** **Required Qualifications** + Active Licensed Registered Nurse ( RN ) in the state of Virginia or ... licensure + Previous Medicare/Medicaid experience a plus + Previous experience in utilization management , case management , discharge planning and/or home… more
- Trinity Health (Silver Spring, MD)
- …time **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
- Molina Healthcare (Alexandria, VA)
- **JOB DESCRIPTION** For this position we are seeking a ( RN ) Registered Nurse or LCSW who lives in VIRGINIA and must be licensed for the state of VIRGINIA. ... integrated) performing one or more of the following activities: care review / utilization management (prior authorizations, inpatient/outpatient medical… more
- Humana (Washington, DC)
- …part of our caring community and help us put health first** The Utilization Management Behavioral Health Professional 2 utilizes behavioral health knowledge and ... and communication of medical services and/or benefit administration determinations. The Utilization Management Behavioral Health Professional 2 work assignments… more
- Humana (Washington, DC)
- …of our caring community and help us put health first** The Manager, Utilization Management Behavioral Health utilizes behavioral health knowledge and skills to ... of medical services and/or benefit administration determinations. The Manager, Utilization Management Behavioral Health works within specific guidelines… more
- Ivyhill Technologies LLC (Bethesda, MD)
- … Nurse and the the RM Reviewers. Requirements Qualified candidate must be a Licensed Registered Nurse ( RN ), with an unencumbered active RN license ... Ivyhill is currently seeking to hire Referral Management ( RN ) Training Manager to support...have three (3) years of clinical nursing experience. Referral Management (RM) and Utilization Management … more
- Guardian Life (Washington, DC)
- …services. Act as a liaison between all parties required in case management to facilitate collaboration toward RTW goals. Utilization of independent ... **Position Summary** The RN Clinical Consultant serves as a clinical resource...issues, when possible, to enhance the customer experience. **Activity** Review and assess claimant subjective reports and objective medical… more
- Sedgwick (Washington, DC)
- …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
- BrightSpring Health Services (Arlington, VA)
- …Education: + Bachelor's Degree in Nursing or the equivalent + Currently licensed as a Registered Nurse ( RN ), in good standing in state of residence ... and direction in performance improvement, provision of clinical services, survey management , documentation management , incident management , EMR/EHR… more
- Sunrise Senior Living (Arlington, VA)
- …of approved college / school of nursing + Maintains a current state license as a Registered Nurse per state regulations. + A minimum of two (2) years' experience ... the highest quality standards for well-being. + Ensures proper utilization of the Resident Care Plan by all team...in a nurse management position within a skilled nursing… more