- AmeriHealth Caritas (Washington, DC)
- …Under the direction of a supervisor, the Clinical Care Reviewer - Utilization Management evaluates medical necessity for inpatient and outpatient services, ... overtime, and weekends based on business needs **Responsibilities** + Conduct utilization management reviews by assessing medical necessity, appropriateness of… more
- Sharecare (Washington, DC)
- …appropriate resource utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during their interactions with participants ... learn more, visit www.sharecare.com . **Job Summary:** The Disease Management Nurse has the responsibility for supporting...and to take the pre and post tests to review competency during orientation. Yearly competency tests are required… 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
- BAYADA Home Health Care (Falls Church, VA)
- …operations. This individual will be responsible for overseeing the day-to-day management of the agency, ensuring high-quality patient care, regulatory compliance, ... metrics including admission rates, re-hospitalizations, visit productivity, and clinician utilization . + Collaborate with referral sources, physicians, hospitals, and… more
- Fresenius Medical Center (Clinton, MD)
- …and acts as the liaison for patient care as per the disease management agreement, including initial and ongoing validation of member eligibility. Facilitate timely ... workup of patients for access management , dialysis services, patient education, hospitalizations, and kidney transplantation as appropriate, and ensures coordination… 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
- GetWellNetwork, Inc. (Washington, DC)
- …Manager will take the Get Well program to the next level by driving nurse engagement, focusing on increased utilization , and leading projects of functionality to ... Well's Client Service Manager is responsible for effective product utilization and successful outcomes for the Get Well system...of the Get Well system by conducting quarterly account review meetings pertaining to account roadmap; conduct nurse… more
- Trinity Health (Silver Spring, MD)
- …experience in the development and management of quality, risk, and utilization review processes. + Strong leadership, communication, and analytical skills. + ... a high level of patient satisfaction and effective resource utilization . + Collaborate with certified nurse midwives,...deliver comprehensive care. + Participate in quality, risk, and utilization review processes. + Supervise and teach… more
- CVS Health (Washington, DC)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... or Specialty Pharmacy. **Preferred Qualifications** + 1+ years' Case Management experience or discharge planning, nurse navigator...lower levels of care. + 1+ years' experience in Utilization Review . + CCM and/or other URAC… more
- Highmark Health (Washington, DC)
- …Highmark Inc. **Job Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of ... and offers interventions and/or alternatives. **ESSENTIAL RESPONSIBILITIES** + Implement care management review processes that are consistent with established… more
- Sunrise Senior Living (Arlington, VA)
- …per state regulations. + A minimum of two (2) years' experience in a nurse management position within a skilled nursing environment including hiring staff, ... education institutions * Higher wage rates * Changes in management * Improved health and wellness benefits starting January...**If you're currently an ADON, Unit Manager, or Charge Nurse ready to take the next step in your… more
- Erickson Living (Springfield, VA)
- …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
- Somatus (Falls Church, VA)
- …and auditing + Ability to work closely with the Director and Clinical Nurse Manager to manage the day-to-day activities and workload of the facility staff, ... feedback in the form of the annual performance evaluation during the performance review process. Obtains feedback and input regarding the staff performance from the… more
- Sunrise Senior Living (Mclean, VA)
- …per state regulations. + A minimum of two (2) years' experience in a nurse management position within a skilled nursing environment including hiring staff, ... education institutions * Higher wage rates * Changes in management * Improved health and wellness benefits starting January...the highest quality standards for well-being. + Ensures proper utilization of the Resident Care Plan by all team… more
- Calvert Memorial Hospital (Prince Frederick, MD)
- + JOB DESCRIPTION DETAILS + Job Summary : + Performs utilization review and discharge planning to patients through the continuum of care. Creates care plans for ... State of Maryland or Compact State preferred. Licensed Practical Nurse (LPN) License acceptable with case management ...Practical Nurse (LPN) License acceptable with case management experience. + Experience : + Position requires a… more
- Erickson Living (Springfield, VA)
- …loss, 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