- Humana (Annapolis, MD)
- …help us put health first** Full-Time, Remote Telephonic opportunity The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- Cognizant (Washington, DC)
- …. Educational background - Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management experience with managed health care plan ... Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced...care revenue cycle or clinic operations . Experience in utilization management to include Clinical … more
- Humana (Annapolis, MD)
- …of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, ... determination of the appropriate courses of action. The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and independent… more
- CVS Health (Washington, DC)
- … solutions that promote high-quality healthcare for members. We are seeking a dedicated Utilization Management (UM) Nurse Consultant to join our remote team. ... listening, and use of a computer. + Flexibility to provide coverage for other Utilization Management (UM) Nurses across various UM specialty teams as needed,… more
- CVS Health (Washington, DC)
- …internal and external constituents in the coordination and administration of the utilization /benefit management function. + Gathers clinical information and ... skills to coordinate, document, and communicate all aspects of the utilization /benefit management program. + Applies critical thinking and knowledge in… more
- AmeriHealth Caritas (Washington, DC)
- …SIGN ON BONUS** **Role Overview:** Under the direction of a supervisor, the Clinical Care Reviewer - Utilization Management evaluates medical necessity ... overtime, and weekends based on business needs. **Responsibilities:** + Conduct utilization management reviews by assessing medical necessity, appropriateness of… more
- Evolent (Washington, DC)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Nurse Reviewer is responsible for performing precertification and prior approvals. Tasks are ... independent nursing judgement and decision-making, physician-developed medical policies, and clinical decision-making criteria sets. Acts as a member advocate by… more
- Fresenius Medical Center (Clinton, MD)
- …requirements. Ensure provision of quality patient care while maintaining cost-effective clinical operations in accordance with all legal, compliance, and regulatory ... and FMS patient care and administrative policies as the clinical leader, has the authority to make daily decisions...the liaison for patient care as per the disease management agreement, including initial and ongoing validation of member… more
- Fresenius Medical Center (Annapolis, MD)
- **About this role:** As a Clinical Manager with Fresenius Medical Care, you will ensure that quality patient care is delivered while maintaining clinical ... or chronic kidney disease. **Training and advancement:** You will enter our Clinical Leadership Program that creates and supports a culture of continuous learning… more
- Sharecare (Washington, DC)
- …helps to drive cost effective and appropriate resource utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during ... for everyone. To learn more, visit www.sharecare.com . **Job Summary:** The Disease Management Nurse has the responsibility for supporting the goals and… more
- CVS Health (Annapolis, MD)
- …of healthcare resources. Applies clinical expertise and knowledge of utilization management principles to influence stakeholders and networks of healthcare ... knowledge and expertise to enhance their understanding of utilization management principles and improve their clinical decision-making. Contributes to the… more
- Erickson Living (Springfield, VA)
- …meetings such as Wound Rounds, Clinical Operations Meeting, Utilization Review, and Performance Improvement/Risk Management /Safety (PI/RM/S) Committee + ... by Erickson Senior Living Join our team as the Nurse Manager, RN also known as the Clinical...and processes in accordance with the Erickson Senior Living Management Policies and Procedures and nursing standards of practice.… more
- Elevance Health (Washington, DC)
- **Medical Management Nurse ** **Location:** Washington, DC. This role requires associates to be in-office 4 days per week, fostering collaboration and ... adaptable workplace. Alternate locations may be considered. The **Medical Management Nurse ** will be responsible for review... experience and requires a minimum of 2 years clinical , utilization review, or managed care experience;… 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 ... self-insured clients. + Application and/or interpretation of applicable criteria and clinical guidelines, standardized care management plans, polices, procedures… more
- Trinity Health (Germantown, MD)
- …Opportunities to advance within the organization **Description:** The Nurse in Charge/ Nurse Supervisor (NIC) is a designated clinical leader for a patient ... Type:** Full time **Shift:** 12 Hour Day Shift **Description:** **Job Title:** Nurse In Charge / Nurse Supervisor **Unit:** Acute Care/Med/Tele **Employment… more
- Ivyhill Technologies LLC (Bethesda, MD)
- …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 a Registered Nurse (Non-Practicing) to support its contract with the Integrated Referral Management and Appointing Center… more
- Highmark Health (Washington, DC)
- …Degree in Nursing **EXPERIENCE** **Required** + 7 years in any combination of clinical , case/ utilization management and/or disease/condition management ... panel of members that range in health status/severity and clinical needs; and assesses health management needs...first 6 months of employment. **Preferred** + Certification in utilization management or a related field +… more
- Trinity Health (Silver Spring, MD)
- …needs. As the designated Nurse Supervisor, you'll coordinate staffing, resource management , and clinical workflows to ensure optimal outcomes and regulatory ... **Employment Type:** Full time **Shift:** Day Shift **Description:** ** Clinical Nurse Supervisor - Dialysis** **Location: Holy Cross Hospital** **Employment… more
- Trinity Health (Silver Spring, MD)
- …Advancement Program + **Location:** Holy Cross Health, Silver Spring, MD **Description:** The Nurse Supervisor is a designated clinical leader for a patient care ... **Employment Type:** Full time **Shift:** Day Shift **Description:** **Job Title:** Nurse Supervisor- IMC **Employment** **Type:** Full time / Day Shift… more
- Evolent (Washington, DC)
- …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and ... accomplishments. **What You Will Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to company… more