- Humana (Annapolis, MD)
- …community and help us put health first** Full-Time, Remote Telephonic opportunity The Utilization Management Nurse 2 utilizes clinical nursing skills to ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...appropriate courses of action. As a Utilization Management RN working on the OneHome/ Home Solutions… more
- Humana (Washington, DC)
- …a part of our caring community and help us put health first** The Weekend 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
- Humana (Annapolis, MD)
- **Become a part of our caring community and help us put health first** 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
- 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
- Trinity Health (Silver Spring, MD)
- …MD Area** **Position Overview - Day 1 Benefits, 10k Sign-on Bonus & More** As a Home Health Registered Nurse , you'll provide in- home skilled nursing care to ... **Employment Type:** Full time **Shift:** **Description:** **Holy Cross Home Care Team is looking for a Fu**...savings that make a difference. + **Supportive Leadership** Our management team is here to help you succeed every… more
- Veterans Affairs, Veterans Health Administration (Washington, DC)
- Summary The primary purpose of the Registered Nurse , Same Day Patient Unit is to demonstrate leadership in delivering and improving holistic care through ... in the assigned area. The Same Day Patient Unit Nurse RN provides comprehensive nursing care for the patient...clinical expertise to improve quality of care and resource utilization with improved outcomes for the immediate practice setting.… 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 ... Abuse or Maternity/ Obstetrics experience. **Preferred Qualifications** + 1+ years' Case Management experience or discharge planning, nurse navigator or nurse… more
- Lincoln Financial (Washington, DC)
- …and/or proficiency with Disability Management (STD/LTD) knowledge, Workers Compensation, Utilization Review and/or nurse case management preferred skills ... **Alternate Locations:** Work from Home **Work Arrangement:** Remote : Work at ...We are excited to bring on a highly motivated Nurse Disability Consultant to our clinical organization. This position… 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 ... Be Doing:** + Practices and maintains the principles of utilization management and appeals management ...all employees have the following technical capability at their home : High speed internet over 10 Mbps and, specifically… more
- Trinity Health (Silver Spring, MD)
- …high-quality care to patients with complex renal needs. As the designated Nurse Supervisor, you'll coordinate staffing, resource management , and clinical ... **Employment Type:** Full time **Shift:** Day Shift **Description:** **Clinical Nurse Supervisor - Dialysis** **Location: Holy Cross Hospital** **Employment Type:… more
- Fresenius Medical Center (Clinton, MD)
- …and acting on adverse events and action thresholds. + Oversees facility's Home Therapies Program if applicable. + Accountable for compliance with all applicable ... and acts as the liaison for patient care as per the disease management agreement, including initial and ongoing validation of member eligibility. Facilitate timely… more
- BrightSpring Health Services (Arlington, VA)
- … utilization and hospital admission reduction. + Provides survey management support/ follow-up/and coordination of corrective actions plans relatied to care ... home health care, + Three years' experience in an administrative/supervisory/quality management role in a Medicare certified home health agency generally… more
- Trinity Health (Silver Spring, MD)
- …Type:** Part time **Shift:** Weekend Shift **Description:** **Position Purpose:** Our Home Care RNs (Primary Care Nurses) provides primary nursing care to ... home based care patients as ordered by the physician,...and LPNs as needed. Provides therapeutic intervention, overall care management and achievement of top decile client outcomes and… more
- Somatus (Falls Church, VA)
- …kidney disease to experience more days out of the hospital and healthier at home . It takes a village of passionate and tenacious innovators to revolutionize an ... in building Proforma's + Ability to manage multiple facilities, including Home Therapy Modalities. Collaboration activities include: + Implementing and maintaining a… more
- Sharecare (Washington, DC)
- …/ new hire plan selection, claims issues, ID card issues, grievances/appeals, utilization management (UM) status, including but not limited to medical, ... + Claims adjustments + Grievances and appeals submissions + Utilization management intake or status + Complex...and second opinion. + Referring members to Clinical Advocates ( Nurse ) for conditions that require clinical care and case… more
- HCA Healthcare (Reston, VA)
- …capital equipment requests + You will be responsible for the fiscal management of department; assure proper utilization of organization's financial resources ... protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage,… more