- Fresenius Medical Center (Towson, 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
- CVS Health (Annapolis, MD)
- …+ Perform medical necessity reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse with at least 1 year of experience in a hospital ... setting. + A Registered Nurse that holds an active, unrestricted...lower levels of care. + 1+ years' experience in Utilization Review . + CCM and/or other URAC… more
- Humana (Annapolis, MD)
- …an impact** **Use your skills to make an impact** **Required Qualifications** + **Licensed Registered Nurse ( RN )** in the (appropriate state) with no ... caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing...in an acute care setting + Previous experience in utilization management/ utilization review for a… more
- CenterWell (Annapolis, MD)
- …community and help us put health first** Conviva Care Solutions is seeking a RN who will collaborate with other health care givers in reviewing actual and proposed ... medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that focuses on excellent… 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 Specialist will perform prospective,… more
- CareFirst (Baltimore, MD)
- …in addition to the required work experience. **Licenses/Certifications Upon Hire Required:** + RN - Registered Nurse - State Licensure And/or Compact ... accreditation standards and federal/state regulations and general principles relating to utilization review . + Computer skills, including Microsoft Office… more
- Humana (Annapolis, MD)
- …timeframe **Use your skills to make an impact** **Required Qualifications** + Licensed Registered Nurse ( RN ) Compact license, with no disciplinary action ... caring community and help us put health first** The Utilization Management Behavioral Health Nurse 2 utilizes...Health Provider Disputes based on the business need + Review and extract information from claims + Work in… more
- Amergis (Baltimore, MD)
- …and referrals for psychosocial needs + Participates in Quality Assurance and Utilization Review activities, as directed + Empowers patients in decision-making ... The RN Case Manager is responsible for coordinating continuum...of care activities for assigned patients and ensuring optimum utilization of resources, service delivery, and compliance with medical… more
- Johns Hopkins University (Baltimore, MD)
- …team while maintaining patient confidentiality. **Minimum Qualifications** + Master's Degree in Nursing; Registered Nurse license and Certified as a Nurse ... The Department of Emergency Medicine is seeking a **_Sr. Nurse Practitioner_** to work collaboratively within a multidisciplinary health care team. Responsible for… more
- Johns Hopkins University (Baltimore, MD)
- …while maintaining patient confidentiality. **Minimum Qualifications** + Master's Degree in Nursing. + Registered Nurse license and Certified as a Nurse ... support in response to emergency situations. + Prepare chart documentation for review and counter signature by the physician. + Determine differential diagnosis. +… more
- 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. ... The Department of Emergency Medicine is seeking a **_Sr. Nurse Practitioner_** to work collaboratively within a multidisciplinary health care team. Responsible for… more
- Elevance Health (Hanover, MD)
- ** Nurse Reviewer I** **Virtual:** This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing ... time,** **with rotating weekends.** **New Grads are encouraged to apply!** The ** Nurse Reviewer I** will be responsible for conducting preauthorization, out of… more
- Highmark Health (Annapolis, MD)
- …**Job Description :** **JOB SUMMARY** This job implements effective complimentary utilization and case management strategies for an assigned member panel. Provides ... to appropriate resources for additional support. + Implement care management review processes that are consistent with established industry, corporate, state, and… more
- CareFirst (Baltimore, MD)
- …Assignments are subject to change based on evolving business needs. **Licenses/Certifications** : RN - Registered Nurse - State Licensure And/or Compact ... working in Care Management, Home Health, Discharge Coordination and/or Utilization Review . **Preferred Qualifications** : + Knowledge...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 - State Licensure And/or Compact ... State Licensure RN - Registered Nurse in MD, VA or Washington....experience working in Care Management, Discharge Coordination, Home Health, Utilization Review , Disease Management or other direct… more
- CareFirst (Baltimore, MD)
- …standards. **QUALIFICATIONS:** **Education Level:** High School Diploma or GED **Licenses/Certifications:** + RN - Registered Nurse - State Licensure And/or ... Compact State Licensure RN - Registered Nurse in MD, VA or Washington,...experience working in Care Management, Discharge Coordination, Home Health, Utilization Review , Disease Management or other direct… more
- Deloitte (Baltimore, MD)
- …Bachelor's degree in nursing, medical degree, or physician assistant required + Current Registered Nurse ( RN ) license required + Certified Clinical ... nurse , physician, physician assistant, case manager, clinical documentation specialist, utilization review , informatics RN , Quality, DRG Validation and… more
- CareFirst (Baltimore, MD)
- …strategies to improve individual and team-based performance as needed. **Licenses/Certifications** : + RN - Registered Nurse - State Licensure And/or Compact ... 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 Salary Range: $78,696… more
- Datavant (Annapolis, MD)
- …with clinical knowledge and expertise successfully. Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well versed in DRG downgrade ... of the Denial Prevention Specialist is to effectively defend utilization of available health services, review of...by management Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well… more
- Highmark Health (Annapolis, MD)
- …years of experience in Managed Care **LICENSES or CERTIFICATIONS** **Required** + Registered Nurse **Preferred** + Certified Medical Coder or related **SKILLS** ... and the proper action to complete the retrospective claim review with the goal of proper and timely payment...data to assure appropriate level of payment and resource utilization . It is also used to identify issues which… more