- Ascension Health (Baltimore, MD)
- …qualifications and comparison with associates in similar roles_ **2 years Utilization Review experience preferred.** **Effective communication with healthcare ... providers, patients, and insurance companies to explain utilization review decisions.** **Familiarity with electronic health records and utilization … more
- Ascension Health (Baltimore, MD)
- …experience, location, qualifications and comparison with associates in similar roles_ ** Registered Nurse , Certified Case Manager (CCM, ACM, URAC) preferred ... salary range at the time of the offer._ **Responsibilities** Manage effective utilization review processes, including management of patient statusing processes… more
- CareFirst (Baltimore, MD)
- …is required in addition to the required work experience. **Licenses/Certifications:** + Health Services\ RN - Registered Nurse - State Licensure and/or ... detail can be shared during the interview process. Plans, organizes, and manages utilization review programs. Directs the utilization of referral services.… more
- 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
- 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
- Ascension Health (Baltimore, MD)
- …Connect with your Talent Advisor for additional specifics._ **Responsibilities** Manage assigned Registered Nurse ( RN ) case managers, related activities and ... including but not limited to: Access Authorization and pre-certification, utilization review and denial management, CareCoordination, Collaborative treatment… more
- Fresenius Medical Center (Columbia, MD)
- **PURPOSE AND SCOPE:** The Inpatient Services Charge Nurse is an additional "responsibility" assigned to the Inpatient Services RN , for a limited period of time, ... duties, as assigned by the Program Manager. The Inpatient Services Charge Nurse ensures appropriate provision of Acute Dialysis Services and treatments within… 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
- 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 Management at… 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...of the team to manage heath care cost and utilization **Provider Support** 1. Completes telephonic nursing assessments including… 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...working in Care Management, Home Health, Discharge Coordination and/or Utilization Review . **Preferred Qualifications:** + Knowledge and… more
- Erickson Living (Catonsville, MD)
- …and dehydration. + Participating in Wound Rounds, Operations Meetings, Utilization Review , and Performance Improvement/Risk Management/Safety (PI/RM/S) ... and survey readiness. **What you will need** + Current RN nursing license with no restrictions for the state...3 years' experience in a healthcare leadership role (Charge Nurse , Unit Manager, etc.). + Experience with an electronic… more
- CareFirst (Baltimore, MD)
- … Review , Disease Management, or other direct patient care experience. **Licenses/Certifications:** RN - Registered Nurse - State Licensure And/or Compact ... determinant of health needs. Engage members and providers to review and clarify treatment plans ensuring alignment with medical...State Licensure RN - Registered Nurse in MD, VA or Washington,… more
- CareFirst (Baltimore, MD)
- …**Education Level:** High School Diploma or GED. **Licenses/Certifications:** + **Upon Hire Required:** RN - Registered Nurse - Compact State Licensure ... RN - Registered Nurse in MD, VA, and/or State Licensure in Washington,...experience working in Care Management, Discharge Coordination, Home Health, Utilization Review , Disease Management or other direct… more
- CareFirst (Baltimore, MD)
- …complications. **QUALIFICATIONS:** **Education Level:** High School Diploma or GED. **Licenses/Certifications:** + RN - Registered Nurse - State Licensure ... psychiatric setting. **Preferred Qualifications:** + 2 years' experience in Medical Review , Utilization Management or Case Management at CareFirst BlueCross… more
- 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
- 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 Government Program… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The role of the Quality Review Nurse ( RN ) is to evaluate clinical quality and procedures within the Clinical Appeals & ... is required in addition to the required work experience. **Licenses/Certifications:** + Health Services\ RN - Registered Nurse - State Licensure and/or… more
- Johns Hopkins University (Lutherville, MD)
- …+ Bachelor's Degree in Nursing or related field. + Individual must be a registered nurse , licensed in the State of Maryland or state where practicing. ... The Department of Otolaryngology is seeking a **_CO_** **_Clinical Nurse Manager_** the Clinical Nurse Manager collaborates with the Medical Director and Clinic… 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 ... ensuring field clinical staff meet daily/weekly/monthly/quarterly and annual requirements + Review 's incident report trends - ensures follow up as needed. Conducts… more