- Ascension (Hanover, MD)
- …and salary range at the time of the offer.Responsibilities Manage effective utilization review processes, including management of patient statusing ... for staff in the areas of utilization criteria, appeal and review process, and case management system documentation.Conduct hiring, training, directing,… more
- Ascension (Hanover, MD)
- …functions, including but not limited to: Access Authorization and pre-certification, utilization review and denial management , CareCoordination, ... for staff in the areas of utilization criteria, appeal and review process, and case management system documentation.Develop staff schedule and revises… more
- Veterans Affairs, Veterans Health Administration (Washington, DC)
- …years of case management , utilization management , disease management , auditing or retrospective review experience Reference: For more information on ... achieving desired outcomes for discharge. Advocates for fiscal responsibility in the management of care through effective utilization of resources. Provides… 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 ... specialist for staff in the areas of utilization criteria, appeal and review process, and case management system documentation. + Conduct hiring, training,… more
- Johns Hopkins University (Baltimore, MD)
- …The Research Nurse Manager will be responsible for the overall management of the clinical trials portfolio and clinical research activities within the UAD ... We are seeking a **_CO_** **_Research Nurse Manager_** to work under the Director of...and regulatory specialists), developing and implementing effective clinical trials management strategies including data management and regulatory… more
- Ivyhill Technologies LLC (Bethesda, MD)
- …nursing program. Must have three (3) years of clinical nursing experience. Referral Management (RM) and Utilization Management (UM) experience is preferred. ... referral management services for beneficiaries in the Defense Health Network. Registered Nurse will have overall responsibility for timely review of Right of… more
- Elevance Health (Hanover, MD)
- …in an ambulatory or hospital setting or minimum of 1 year of prior utilization management , medical management and/or quality management , and/or ... required. **Preferred Skills, Capabilities, and Experiences** **:** + Familiarity with Utilization Management Guidelines, ICD-9 and CPT-4 coding, and managed… more
- The Cigna Group (Baltimore, MD)
- …about their care options and make specific recommendations based on their goals 4. Review paperwork for patients to ensure it meets all requirements 5. Explain test ... education including possible side effects, plan of care, and individualized care goals management in a culturally sensitive and acceptable manner for the patient or… 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)
- …an Associate's Degree and a minimum of 2 years of experience in Utilization Management , Referral Management , Authorization/Denials, or Medical Claims ... Team Ivyhill is currently seeking to hire Referral Management (Non- Nurse ) Reviewers to support its...review duties, seeking guidance from the product line nurse (s), and other members of the healthcare team and… more
- Ivyhill Technologies LLC (Bethesda, MD)
- …nursing program. Must have three (3) years of clinical nursing experience. Referral Management (RM) and Utilization Management (UM) experience is preferred. ... Ivyhill is currently seeking to hire Referral Management (RN) Training Manager to support its contract...all incoming RM staff to be able to accurately review referrals utilizing the Specialty Referral Guideline (SRG) compliance… more
- Evolent (Annapolis, MD)
- …for operational performance of physician, nursing, and shared services staff in the utilization management value chain + Owns clinical rationale for ... point of responsibility for all clinical operations inclusive of nurse , physician, and shared services performance. and core work...utilization management decisions made by all clinical staff + Ensures… more
- Trinity Health (Silver Spring, MD)
- … initiatives. Completes comprehensive assessment of patient situations utilizing Case Management documentation standards, review of medical record, collaboration ... position requires a minimum of two years of experience in Social Work Case Management within an acute care facility. Additional training to learn the role will not… more
- CareFirst (Baltimore, MD)
- …leadership experience. + Master's in Science Nursing or related field, Legal Nurse Consultant, Utilization Management , and Government Program experience ... of regulatory and accreditation requirements, understanding of appeals process and utilization management , and systems software used in processing appeals.… more
- Johns Hopkins University (Lutherville, MD)
- …directly to the Ambulatory Services Manager and work collaboratively with the Nurse Manager to ensure the delivery of safe, efficient, and high-quality patient ... reviews with input from the Medical Director, Ambulatory Services Manager, Nurse Manager, and faculty. + Address disciplinary issues promptly and professionally,… more
- Ascension Health (Baltimore, MD)
- …functions, including but not limited to: Access Authorization and pre-certification, utilization review and denial management , CareCoordination, ... the time of the offer._ **Responsibilities** Manage assigned Registered Nurse (RN) case managers, related activities and workflow to...the areas of utilization criteria, appeal and review process, and case management system documentation.… more
- CareFirst (Baltimore, MD)
- …working in Care Management , Home Health, Discharge Coordination and/or Utilization Review . **Preferred Qualifications:** + Knowledge and experience with ... of care utilizing experience and skills in **both** case management and utilization management . To...care. Applies sound clinical knowledge and judgment throughout the review process. Follows member benefit contracts to assist with… more
- University of Maryland, Baltimore (Baltimore, MD)
- …related to the delivery of medical care and clinical services such utilization review , quality assurance, policies, procedures and guidelines development. 3. ... Towson, MD * Staffed with 24 /7 and Neonatal Nurse Practitioners * TeleHealth Support 24/7 from the UMMC...of Maryland Medical Center (UMMC). 8. Provides oversight of utilization and risk management activities including monitoring… more
- Erickson Living (Parkville, MD)
- …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
- Johns Hopkins University (Baltimore, MD)
- …Senior Clinical Research Program Manager will be responsible for the overall management of the clinical trials portfolio and clinical research activities within the ... responsible for managing research staff, developing and implementing effective data management and regulatory procedures, providing education to research staff and… more
