- Luke Staffing (Bethesda, MD)
- …tasks as assigned (eg on call duties). . Participate in the clinic quality assurance, utilization review , risk management , and peer review activities. ... Contract HCW shall demonstrate skills in interviewing, examination, assessment, and management of patients with general medical and surgical health problems.… 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
- Washington Metropolitan Area Transit Authority (Alexandria, VA)
- Senior Financial Management Analyst - Payroll Job ID: 250923 Location: VA - Metro Bldg At Eisenhower Full/Part Time: Full-Time Posting Open-Close 10/10/2025 - ... 10/19/2025 Union NRP Regular/Temporary: Regular **Job Description** **Senior Financial Management Analyst ? Payroll Marketing Statement:** The Washington Metropolitan… more
- Somatus (Mclean, VA)
- …+ Travel (up to 25%) to local renal care providers for quality oversight and utilization review collection + Other duties as assigned. _Please note this job ... and policies of Somatus + Assist Directors of Quality on quality and utilization audits as assigned, including targeted audits as requested by the Director. +… more
- CBRE Government and Defense Services (Reston, VA)
- …Summary** The Director of Operations will be responsible for providing regional management and oversight of aP&L of +$30M of design-build and design-bid-build ... government personnel. Negotiate contracts and bids with vendors and subcontractors. Review jobsite monthly reports and evaluate performance and compliance and lead… more
- CBRE Government and Defense Services (Annapolis, MD)
- …or other systems as directed. + Monitor and report performance metrics, labor utilization , and material usage to support compliance and invoicing. + Enforce safety ... FFP contract. + Assist with budget tracking, material procurement, and inventory management . + Respond to emergencies and manage after-hours calls or escalations as… more
- Battelle Memorial Institute (Fort Belvoir, VA)
- …programs, with additional applications in military engineering, DoD installation management , and USACE projects. **Deliverable:** The primary deliverable for this ... file sizes, and high utility in operational contexts. **Responsibilities** + Review scientific literature to identify and implement appropriate research methods. +… more
- CVS Health (Annapolis, MD)
- …members. **Position Summary** The Associate Manager is responsible for oversight of Utilization Management staff. This position is responsible for the ... team maintains compliance and privacy practices. + Oversees the implementation of utilization management services for assigned area + Implements clinical… 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
- Cognizant (Washington, DC)
- …. Educational background - Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management experience with managed health care plan . 3 years' ... as well as timely filing deadlines and processes. . Review clinical denials including but not limited to referral,...care revenue cycle or clinic operations . Experience in utilization management to include Clinical Appeals and… 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
- 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
- Humana (Annapolis, MD)
- …The Care Management Support Assistant 2 contributes to administration of care management , utilization management and daily operations. The ACD RC duties ... authorizations. + Coordinates authorizations with Autism Services Navigators and Utilization Management according to established HUMANA GOVERNMENT BUSINESS… 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
- Koniag Government Services (Germantown, MD)
- …weapons design, nuclear material production, counterintelligence, weapon science, and military utilization of nuclear weapons to review and assess documents. ... Services, LLC,** a Koniag Government Services company **,** is seeking a Document Reviewer Level 5 (DRL5) with Top- Secret clearance to support **KPS** and our… more
- Koniag Government Services (Germantown, MD)
- …Professional Services** , a Koniag Government Services company, is seeking a Document Reviewer Level 2 (DRL2) with a Top-Secret clearance to support KPS and our ... Services, a Koniag Government Services company, is seeking an experienced Document Reviewer Level 2 (DRL2) to conduct classification reviews of documents and… more
- Koniag Government Services (Germantown, MD)
- …Professional Services** , a Koniag Government Services company, is seeking a Document Reviewer Level 1 (DRL1) with a Top-Secret clearance to support KPS and our ... Services, a Koniag Government Services company is seeking an entry-level Document Reviewer Level 1 (DRL1) to conduct classification reviews of government agency… more
