- Cognizant (Washington, DC)
- …background - Registered Nurse (RN) + 2-3 years combined clinical and/or utilization management experience with managed health care plan + 3 years' experience ... Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced...care revenue cycle or clinic operations + Experience in utilization management to include Clinical Appeals and… more
- AmeriHealth Caritas (Washington, DC)
- **$5,000.00 SIGN ON BONUS** **Role Overview** Our Utilization Management Reviewers evaluate medical necessity for inpatient and outpatient services, ensuring ... in the least restrictive and most effective manner. The Utilization Management Reviewer must maintain a strong...3 years of diverse clinical experience as a Registered Nurse in an Intensive Care Unit (ICU), Emergency Department… more
- Battelle Memorial Institute (Arlington, VA)
- …as a case manager by a recognized certifying organization, ie, Commission for Case Management Certification or American Nurse Credentialing Center + At least two ... Research and Analytics (HRA) business line is seeking a highly motivated, full-time ** Nurse Case Manager** to join our team in support of our government customer,… more
- Immigration and Customs Enforcement (Washington, DC)
- …health facility surveyors and in collaboration with the IHSC Medical Quality Management Unit. SUPERVISORY CONTROLS: The Clinical Senior Nurse Specialist, Medical ... clinical and administrative nursing support, and collaborating with the IHSC Chief Nurse in the Nursing Services Unit to implement initiatives aimed at enhancing… more
- Evolent (Washington, DC)
- …Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. Tasks are performed ... medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care across the continuum… more
- Evolent (Washington, DC)
- …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and ... **What You Will Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to company policies and… more
- Elevance Health (Washington, DC)
- …with providers, claims or service issues. + Assists with development of utilization /care management policies and procedures, chairs and schedules meetings, as ... ** Nurse Case Manager Sr** **Location:** Washington, DC. This... Case Manager Sr** will be responsible for care management within the scope of licensure for members with… more
- Fresenius Medical Center (Washington, DC)
- …Classification of Disease (ICD) coding. + Manages clinic financials including efficient utilization of supplies or equipment and regular profits and loss review. + ... + Preferred but not required: + 3+ years supervisory or project/program management experience. + Med/surg or ICU/CCU experience. **PHYSICAL DEMANDS AND WORKING… more
- Select Medical (Alexandria, VA)
- … within the plan of care. + Demonstrates compliance with facility-wide Utilization Management policies and procedures. + Coordinates UR compliance with ... current licensure in a clinical discipline either as a Nurse or a Respiratory Therapist OR Social Work SW/MSW...what is right. The Case Manager is responsible for utilization reviews and resource management , discharge planning,… more
- Select Medical (Alexandria, VA)
- … within the plan of care. + Demonstrates compliance with facility-wide Utilization Management policies and procedures. + Coordinates UR compliance with ... current licensure in a clinical discipline either as a Nurse (RN/LPN/LVN) or a Respiratory Therapist (RT) OR Medical...what is right. The Case Manager is responsible for utilization reviews and resource management , discharge planning,… more
- Erickson Living (Springfield, VA)
- …leadership meetings such as Wound Rounds, Clinical Operations Meeting, Utilization Review, and Performance Improvement/Risk Management /Safety (PI/RM/S) Committee ... by Erickson Senior Living Join our team as the Nurse Manager, RN also known as the Clinical Manager!...and processes in accordance with the Erickson Senior Living Management Policies and Procedures and nursing standards of practice.… more
- Immigration and Customs Enforcement (Washington, DC)
- …and supervising field leaders. Responsibilities include compliance monitoring, risk management , performance improvement for ICE medical standards and public health, ... Field Training Program Officer (SFTPO), and Regional Section Chiefs (RSCs) with effective management of unit operations and case management of patients in the… more
- Highmark Health (Washington, DC)
- …and education or if necessary involve Special Investigation Unit or the Utilization Management area. **ESSENTIAL RESPONSIBILITIES** + Implement the pre-payment ... itemized bills, and claims data to assure appropriate level of payment and resource utilization . It is also used to identify issues which can be used for education… more
- Sunrise Senior Living (Fort Belvoir, VA)
- …per state regulations + A minimum of two (2) years' experience in a nurse management position within a skilled nursing environment including hiring staff, ... of Nursing Services is responsible for providing leadership and management to the skilled nursing operations. Responsible for planning,...highest quality standards for well being. + Ensures proper utilization of the Resident Care Plan by all team… more
- Deloitte (Washington, DC)
- …to collaborate with clinicians, physicians, NP/PAs, ancillary departments, Quality, Case Management , Finance, Revenue Cycle, and Coders + Other skills include the ... both formal and informal education of physicians, CDI team, health information management and other clinical staff + Develop in-service education tools as necessary… more
- Howard University Hospital (Washington, DC)
- …placement of admitted patients. The incumbent assists in the formulation of a nurse float pool and coordinates the daily use of supplement staff. The incumbent ... Clinical Nursing Administrator : Provides leadership, coordination and management of personnel, and assumes responsibility for hospital administrative functions… more
- Fresenius Medical Center (Arlington, VA)
- …procedure, under the direction of the Facility Manager and/or Charge Registered Nurse , utilizing standard nursing techniques to assist the physician in optimum ... acting on adverse events and action thresholds in collaboration with facility management . + Maintains integrity of medical records and other FVC administrative and… more
- Erickson Living (Springfield, VA)
- …and dehydration. + Participating in Wound Rounds, Operations Meetings, Utilization Review, and Performance Improvement/Risk Management /Safety (PI/RM/S) ... a plus. + Minimum 3 years' experience in a healthcare leadership role (Charge Nurse , Unit Manager, etc.). + Experience with an electronic medical record (EMR) system… more
- Battelle Memorial Institute (Arlington, VA)
- …operations and high-quality patient care. **Responsibilities** + Assist with the management and treatment of outpatient behavioral health activities + Under the ... supervision of a licensed psychiatrist, social worker, psychiatric nurse or psychologist, responsible for providing a wide range of behavioral health interventions… more
- Philips (Washington, DC)
- …+ Ability to effectively manage assigned accounts in terms of driving utilization , customer relationship management , problem resolution, etc. + You must ... equipment etc) with clinical experience as Radiologic Technologist (RT) or Registered Nurse (RN) highly preferred. + Experience in healthcare (in the hospital)… more