• Registered Nurse

    Ascension Health (Baltimore, MD)
    …Provide health care services regarding admissions, case management, discharge planning and utilization review . Responsibilities: + Review admissions and ... planning needs with healthcare team members. + May prepare statistical analysis and utilization review reports as necessary. + Oversee and coordinate compliance… more
    Ascension Health (03/14/25)
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  • Utilization Management Specialist (Remote)

    CareFirst (Baltimore, MD)
    …experience is required in addition to the required work experience. **Licenses/Certifications:** + RN - Registered Nurse - State Licensure And/or Compact ... **Resp & Qualifications** **PURPOSE:** Utilizing key principles of utilization management, the Utilization Review...Upon Hire Required or + LPN - Licensed Practical Nurse - State Licensure Upon Hire Required + CNS-Clinical… more
    CareFirst (02/21/25)
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  • RN Clinical Manager

    Erickson Living (Parkville, MD)
    …leadership meetings such as Wound Rounds, Clinical Operations Meeting, Utilization Review , and Performance Improvement/Risk Management/Safety (PI/RM/S) Committee ... (skilled nursing, long term care, assisted living or hospital) is required. + Current Registered Nurse license for the state in which they operate. + Current… more
    Erickson Living (01/21/25)
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  • Population Health Nurse ( RN

    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 ... including but not limited to: Access Authorization and pre-certification, utilization review and denial management, CareCoordination, Collaborative treatment… more
    Ascension Health (02/04/25)
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  • Dialysis Program Manager, Registered

    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
    Fresenius Medical Center (03/04/25)
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  • Registered Nurse (Home Based Primary…

    Veterans Affairs, Veterans Health Administration (Baltimore, MD)
    …ineligible to apply. Responsibilities Duties: Home Based Primary Care (HBPC) Outpatient Staff Registered Nurse ( RN ) is responsible for providing competent, ... equivalent to a bachelor's level degree in Nursing may have opportunity to become registered as a nurse with a state licensing board prior to completion… more
    Veterans Affairs, Veterans Health Administration (03/15/25)
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  • Clinical Navigator (Hybrid)

    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...working in Care Management, Home Health, Discharge Coordination and/or Utilization Review . **Preferred Qualifications:** + Knowledge and… more
    CareFirst (02/21/25)
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  • Clinical Appeals Nurse (Remote)

    CareFirst (Baltimore, MD)
    …treatment needs or those with substance disorders and addictions. **Licenses/Certifications** : + RN - Registered Nurse - State Licensure And/or Compact ... psychiatric setting. **Preferred Qualifications** : + 2 years experience in Medical Review , Utilization Management or Case Management at CareFirst BlueCross… more
    CareFirst (02/15/25)
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  • Clinical Appeals Supervisor (Hybrid)

    CareFirst (Baltimore, MD)
    …organization or hospital. Demonstrated leadership skills. In Lieu of Education. **Licenses/Certifications:** + RN - Registered Nurse - State Licensure And/or ... similar clinical experience OR 5 years' experience in Medical Review , Utilization Management or Case Management at...Case Manager Upon Hire Preferred + LNCC - Legal Nurse Consultant Certified Upon Hire Preferred **Preferred Qualifications:** +… more
    CareFirst (03/04/25)
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  • RN Hospice Case Manager

    Amergis (Columbia, MD)
    The Registered Nurse - Hospice Case Manager is responsible for providing care, comfort and supportto terminally ill patients. The Registered Nurse - ... and accountability for the delivery of hospice patient carein various settings. The Registered Nurse demonstrates the abilityto make clinical judgments in an… more
    Amergis (03/04/25)
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  • Nurse Practitioner

    Johns Hopkins University (Baltimore, MD)
    …fluids with blood borne pathogens. **Minimum Qualifications** + Master's Degree in Nursing. + Registered Nurse license and Certified as a Nurse Practitioner. ... support in response to emergency situations. + Prepare chart documentation for review and counter signature by the physician. + Determine differential diagnosis. +… more
    Johns Hopkins University (03/11/25)
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  • Nurse Audit Sr

    Elevance Health (Hanover, MD)
    …fraud and over- utilization by performing medical reviews via prepayment claims review and post payment auditing. + Correlates review findings with ... ** Nurse Audit Sr** **Location:** This position will work...responsible for identifying, monitoring, and analyzing aberrant patterns of utilization and/or fraudulent activities by health care providers through… more
    Elevance Health (03/15/25)
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