- Humana (Annapolis, MD)
- …and help us put health first** Humana Healthy Horizons in Ohio is seeking a Utilization Management Nurse 2 who utilizes clinical nursing skills to support ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...skills to make an impact** **Required Qualifications** + Licensed Registered Nurse ( RN ) with no… more
- Ascension Health (Baltimore, MD)
- …and salary range at the time of the offer._ **Responsibilities** Manage effective utilization review processes, including management of patient statusing ... location, qualifications and comparison with associates in similar roles_ ** Registered Nurse , Certified Case Manager (CCM, ACM,...the areas of utilization criteria, appeal and review process, and case management system documentation.… more
- 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 (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
- 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
- The Cigna Group (Baltimore, MD)
- The RN Coordinator serves as the key contact point for...as needed 3) 3+ years of experience as a Registered Nurse 4) Proficient level of experience with ... and make specific recommendations based on their goals 4. Review paperwork for patients to ensure it meets all...side effects, plan of care, and individualized care goals management in a culturally sensitive and acceptable manner for… more
- Highmark Health (Annapolis, MD)
- …and Sunday required in addition to 3 weekdays** This job implements effective utilization management strategies including: review of appropriateness of ... and offers interventions and/or alternatives. **ESSENTIAL RESPONSIBILITIES** + Implement care management review processes that are consistent with established… more
- CareFirst (Baltimore, MD)
- …people. **QUAIFICATIONS:** **Education Level:** High School Diploma or GED. **Licenses/Certifications:** + RN - Registered Nurse - State Licensure And/or ... **Resp & Qualifications** **PURPOSE:** The Clinical Appeals Supervisor ( RN ) directs and coordinates the accurate implementation of...clinical experience OR + 5 years experience in Medical Review , Utilization Management or Case… more
- CareFirst (Baltimore, MD)
- …experience, previous case management , discharge planning or utilization review experience. **Licenses/Certifications** RN - Registered Nurse ... **Resp & Qualifications** **PURPOSE:** The Clinical Medical Review Nurse handles day to day review of professional and institutional claims and provider… 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 ... functions, including but not limited to: Access Authorization and pre-certification, utilization review and denial management , CareCoordination,… more
- CareFirst (Baltimore, MD)
- …care, and experience reviewing patient medical care Demonstrated leadership skills. **Licenses/Certifications** RN - Registered Nurse - State Licensure ... **Resp & Qualifications** **PURPOSE:** Supervise the daily operations of the utilization management (UM) department functions to ensure appropriate coordination… 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
- Amergis (Hunt Valley, MD)
- The Registered Nurse - Hospice Case Manager is responsible for providing care, comfort and support to terminally ill patients. The Registered Nurse - ... delivery of hospice patient care in various settings. The Registered Nurse demonstrates the ability to make...in managing patient care and assisting others in the management of patient care. Position Details: + Location: Baltimore… more
- Intermountain Health (Annapolis, MD)
- …REGISTRATION, LICENSE (*indicates primary source verification requirement) Required: + Active Registered Nurse License Preferred: + Certified Healthcare Access ... Associate (CHAA) EXPERIENCE Required: + Licensed Registered Nurse + Minimum of 2 years'...experience in acute clinical nursing setting + Knowledge of utilization management and case management … more
- CareFirst (Baltimore, MD)
- …experience is required in addition to the required work experience. **Licenses/Certifications:** + RN - Registered Nurse - State Licensure And/or Compact ... with dynamic goals resulting in the full and fair review of appeals and designed to achieve corporate objectives...+ Master's in Science Nursing or related field, Legal Nurse Consultant, Utilization Management , and… more
- Erickson Living (Parkville, MD)
- …clinical leadership meetings such as Wound Rounds, Clinical Operations Meeting, Utilization Review , and Performance Improvement/Risk Management /Safety ... and processes in accordance with the Erickson Senior Living Management Policies and Procedures and nursing standards of practice....care, assisted living or hospital) is required. + Current Registered Nurse license for the state in… more
- Guardian Life (Annapolis, MD)
- …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
- 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...Care Management , Home Health, Discharge Coordination and/or Utilization Review . **Preferred Qualifications:** + Knowledge and… more
- BrightSpring Health Services (Baltimore, MD)
- …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
- United Therapeutics (Annapolis, MD)
- …Degree preferably in a health, biological sciences, or related field or + Registered Nurse ( RN ) nursing qualifications or relevant clinical research ... with superior financial performance and our communities with earth-sensitive energy utilization . Our company was founded by an entrepreneur whose daughter was… more