- Quadrant Inc (Washington, DC)
- …in the management of patient care between visits Assists in the management of patient utilization of health care system and provides patient education ... and patient has been notified Provides related education, counseling, ongoing review , and monitoring regarding diagnostic tests under the collaboration of the… more
- Somatus (Mclean, VA)
- …Integrity Product Areas:** Clinical Claim Review , Payment Analytics, Fraud Capture, Utilization Review **Product Management ** + **Build** business cases ... our mission. Responsibilities **The Impact** **You'll** **Make:** + **Lead** performance management tied to key metrics and business drivers that inform strategic… more
- Parexel (Washington, DC)
- …mitigations and drive resolution with cross-functional stakeholders as part of the Risk Management Plan. + Review and analyze metrics to derive meaningful ... Leadership:** + Manage and coordinate the integration and utilization of all ancillary systems. + Highlight issues/risks to...project-level resourcing of staff and staff assignments. + Regularly review and update Data Management resources to… more
- NuAxis Innovations (Washington, DC)
- **IT Asset Management Lead** Location **Washington, DC** \# of openings **1** Salary Range (Min-Max) **00** **We are a federal IT company on a mission to make ... join our team NOW! We are currently seeking a talented and motivated **IT Asset Management Lead** for a Full-Time position. The IT Asset Management Lead is… more
- Red River (Washington, DC)
- …Residency Services Manager will be responsible for our residents' growth and operational management in the field full-time for the project's duration for any given ... field operatives working at a full time, or 100% utilization less time off. + Leverage SKU-based residency services...of 30% GP. + Build and manage Residency Project Management Office to manage customer expectations around delivery which… more
- Office of the Secretary of Defense (Arlington, VA)
- …systems with program initiatives and utilizes advanced technology for effective data management , ensuring the department remains at the forefront of financial ... management practices. Provide expert advice, oversee budget policy, and...oversee budget policy, and recommend efficient and effective fund utilization strategies. Develop and managing long-term budget plans and… more
- GCG (Washington, DC)
- …Drive change management and user training to ensure effective system utilization across the organization + Monitor system performance and user feedback to ... Business Partners to support talent reviews, succession planning, and performance management , while managing and facilitating key development programs. You will… more
- Washington Metropolitan Area Transit Authority (New Carrollton, MD)
- …of Metro?s transit modes. The Safety Specialist also supports Safety Management Systems implementation by directly interfacing with operations and maintenance ... necessity. **Minimum Qualifications** Education + Bachelor?s Degree in Engineering, Safety Management , Rail Accident Investigation, or related field + In lieu of… more
- Jobleads-US (Baltimore, MD)
- …Drives renewal process and can lead client meetings regarding renewals and utilization review . Introduces new products and promotes them through regular ... offers a strategic and consultative approach to employee benefits account management . Primary Responsibilities: Manages a complex book of business with varying… more
- AmeriHealth Caritas (Washington, DC)
- …BONUS** **Role Overview:** Under the direction of a supervisor, the Clinical Care Reviewer - Utilization Management evaluates medical necessity for inpatient ... overtime, and weekends based on business needs. **Responsibilities:** + Conduct utilization management reviews by assessing medical necessity, appropriateness of… more
- Humana (Annapolis, MD)
- …MDS Coordinator or discharge planner in an acute care setting + Previous experience in utilization management / utilization review for a health plan or ... of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination,… more
- Humana (Washington, DC)
- …**Preferred Qualifications:** + Experience in managed care pharmacy, particularly in utilization management review **Additional Information:** **Interview ... our caring community and help us put health first** The Staff Utilization Management Pharmacist (VSP/PT) is a clinical expert responsible for conducting medical… more
- Humana (Washington, DC)
- …put health first** The UM Administration Coordinator contributes to administration of utilization management . The UM Administration Coordinator 2 performs varied ... new systems (proficient to advanced) **Preferred Qualifications** + Experience with Utilization Review and/or Prior Authorization, preferably within a managed… more
- CVS Health (Annapolis, MD)
- …with behavioral health background. **Preferred Qualifications** + 3 years Managed care/ utilization review experience preferred. + Crisis intervention skills and ... clinical skills to coordinate, document and communicate all aspects of the utilization /benefit management program. Applies critical thinking and is knowledgeable… more
- Elevance Health (Hanover, MD)
- **Nurse Reviewer I** A proud member of the Elevance...hospital setting or minimum of 1 year of prior utilization management , medical management and/or ... state(s) required. **Preferred Skills, Capabilities, and Experiences:** + Familiarity with Utilization Management Guidelines, ICD-9 and CPT-4 coding, and managed… more
- Evolent (Washington, DC)
- …Reviewer , Interventional Pain Management , you will be a key member of the utilization management team. We can offer you a meaningful way to make a ... Will Be Doing:** + Serve as the Physician Clinical Reviewer for Interventional Pain Management , reviewing cases... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more
- Humana (Washington, DC)
- …. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial ... their daily work. The Medical Director's work includes computer-based review of moderately complex to complex clinical scenarios, ...with prior experience participating in teams focusing on quality management , utilization management , case … more
- CVS Health (Annapolis, MD)
- …experience. + CISM experience. + Human Resource and/or Supervisory experience. + Case management , Utilization Review , or Utilization Management ... am to 8:00 pm Eastern Time.** The Consultant provides management consultation to corporate clients around issues of safety...member clinical assessments and triage into care. Performs case management across scope of all types of management… more
- Evolent (Washington, DC)
- …the mission. Stay for the culture. **What You'll Be Doing:** **Cardiovascular Utilization Management Reviewer (Interventional Cardiologist)** Are you ready ... on patient care in a non-clinical setting? Join our Utilization Management team as a Field Medical... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more
- Highmark Health (Washington, DC)
- …:** **JOB SUMMARY** This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and ... and DOL regulations at all times. In addition to utilization review , the incumbent participates as the...member of the multidisciplinary team for case and disease management . They will advise the multidisciplinary team on cases,… more
