- Elevance Health (Hanover, MD)
- **Clinical Operations Medical Director** ** Utilization Management of Medical Oncology Benefits** **Carelon Benefits Management ** **$20,000 Sign On Bonus** ... members and providers. **Job Summary:** + Perform physician-level case review , following initial nurse review ,...maintain knowledge of relevant policies and regulations pertaining to utilization review of oncology care. + Participate… more
- Lincoln Financial Group (Annapolis, MD)
- …Experience and/or proficiency with Disability Management (STD/LTD) knowledge, Workers Compensation, Utilization Review and/or nurse case management ... Role at a Glance** We are excited to bring on a highly motivated Nurse Disability Consultant to our clinical organization. This position will be responsible for… more
- Johns Hopkins University (Columbia, MD)
- The Department of Emergency Medicine is seeking a **_Sr. Nurse Practitioner_** to work collaboratively within a multidisciplinary health care team. This Position ... and appropriate measures in acute and chronic illness. The Sr. Nurse practitioner will direct supervision from appropriate licensed physician as designated.… more
- Johns Hopkins University (Baltimore, MD)
- The Department of Emergency Medicine is seeking a **_Sr. Nurse Practitioner_** to work collaboratively within a multidisciplinary health care team. Responsible for ... support in response to emergency situations. + Prepare chart documentation for review and counter signature by the physician. + Determine differential diagnosis. +… more
- Fresenius Medical Center (Lanham Seabrook, 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)
- …welcome. **Knowledge, Skills and Abilities (KSAs)** + Knowledge of NCQA requirements of utilization review , Case Management standards and guidelines, appeal ... Corporate Strategic Plan through direction of the Clinical Medical Claims Review , Medical Underwriting, Medical Policy, Clinical Appeals and Analysis programs and… more
- CenterWell (Annapolis, MD)
- …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and ... requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking...and reliable transportation. + Two years as a Registered Nurse with at least one-year of management … more
- Ascension Health (Baltimore, MD)
- …functions, including but not limited to: Access Authorization and pre-certification, utilization review and denial management , CareCoordination, ... specialist for staff in the areas of utilization criteria, appeal and review process, and case management system documentation. + Develop staff schedule and… 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 including...care. Applies sound clinical knowledge and judgment throughout the review process. Follows member benefit contracts to assist with… more
- CareFirst (Baltimore, MD)
- …related experience working in Care Management , Discharge Coordination, Home Health, Utilization Review , Disease Management , or other direct patient care ... determinant of health needs. Engage members and providers to review and clarify treatment plans ensuring alignment with medical...CCM/ACM or other RN Board Certified certification in case management . Incumbents not certified at the time of hire… more
- CareFirst (Baltimore, MD)
- …in the specialty of Pediatric Care Management , Discharge Coordination, Home Health, Utilization Review , Disease Management or other direct patient care ... and/or social determinant of health needs. Engage members and providers to review and clarify treatment plans ensuring alignment with medical benefits and policies… more