- Elevance Health (Washington, DC)
- RN Utilization Review Nurse (Washington DC Medicaid) JR149756 **Location** : This role requires associates to be in-office 4 days per week, Monday - ... located at 609 H. Street NE. The **Medical Management Nurse ** is responsible for review of the...experience and requires a minimum of 2 years clinical, utilization review , or managed care experience; or… more
- Ascension Health (Baltimore, MD)
- …Provide health care services regarding admissions, case management, discharge planning and utilization review . Responsibilities: + Review admissions and ... planning needs with healthcare team members. + May prepare statistical analysis and utilization review reports as necessary. + Oversee and coordinate compliance… more
- AmeriHealth Caritas (Washington, DC)
- …Degree in Nursing (ASN) required; Bachelor's Degree in Nursing (BSN) preferred. + A DC ; Registered Nurse ( RN ) license in good standing is required. + 3+ ... efficiently document and assess patient cases. + Strong understanding of utilization review processes, including medical necessity criteria, care coordination,… more
- The Arora Group (Bethesda, MD)
- Registered Nurse Case Manager Nurse Currently recruiting a Registered Nurse ( RN ) Case Manager to work the Directorate of Healthcare Operations ... be provided one month in advance. DUTIES OF THE REGISTERED NURSE CASE MANAGER ( RN ):...cost diagnoses. + Independently perform difficult and complex assessment, review , coordination, planning, monitoring, evaluation and analysis of cases.… more
- Fresenius Medical Center (Baltimore, 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
- Sharecare (Annapolis, MD)
- …cost effective, appropriate resource utilization and quality outcomes. The Clinical Registered Nurse is also responsible for early identification of those ... for everyone. To learn more, visit www.sharecare.com . **Job Summary:** The Clinical Registered Nurse has the responsibility for supporting the goals and… more
- Ivyhill Technologies LLC (Bethesda, MD)
- …referral management services for beneficiaries in the Defense Health Network. Registered Nurse will have overall responsibility for timely review of Right of ... of Specialty Care Referrals, sustaining up-to-date Specialty Clinic Referral Review tools and booking guidance, complying with Referral and...RM Team. Requirements Qualified candidate must be a Licensed Registered Nurse ( RN ), with an… more
- Ascension Health (Baltimore, MD)
- …job transfer date required. American Heart Association or American Red Cross accepted. + Registered Nurse obtained prior to hire date or job transfer date ... required. Education: + Required professional licensure/certification AND 3 years of experience and 1 year of cumulative leadership experience required. **Additional Preferences** \#ATP **Why Join Our Team** Ascension associates are key to our commitment 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
- Amergis (Columbia, MD)
- Salary: $53 / Hour The Registered Nurse - Hospice Case Manager is responsible for providing care, comfort and supportto terminally ill patients. The Registered ... the delivery of hospice patient carein various settings. The Registered Nurse demonstrates the abilityto make clinical...in the managementof patient care. Position Details: + Position: RN Hospice Case Manager (Home Health- Based) + Location:… more
- Ivyhill Technologies LLC (Bethesda, MD)
- … Nurse and the the RM Reviewers. Requirements Qualified candidate must be a Licensed Registered Nurse ( RN ), with an unencumbered active RN license ... Ivyhill is currently seeking to hire Referral Management ( RN ) Training Manager to support its contract with...all incoming RM staff to be able to accurately review referrals utilizing the Specialty Referral Guideline (SRG) compliance… more
- Erickson Living (Parkville, MD)
- …leadership meetings such as Wound Rounds, Clinical Operations Meeting, Utilization Review , and Performance Improvement/Risk Management/Safety (PI/RM/S) Committee ... (skilled nursing, long term care, assisted living or hospital) is required. + Current Registered Nurse license for the state in which they operate. + Current… more
- BrightSpring Health Services (Baltimore, MD)
- …Education: + Bachelor's Degree in Nursing or the equivalent + Currently licensed as a Registered Nurse ( RN ), in good standing in state of residence ... ensuring field clinical staff meet daily/weekly/monthly/quarterly and annual requirements + Review 's incident report trends - ensures follow up as needed. Conducts… more
- Johns Hopkins University (Columbia, 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
- 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
- Trinity Health (Silver Spring, MD)
- …appropriate hospital resource utilization . + Oversees key functions including utilization review , discharge planning, and care coordination. + Utilizes ... responsibility for the following direct reports: + Manager of Utilization Review and Case Management + Manager...basis, with the Vice President of Patient Care Services ( Nurse Executive), the Vice President of the Medical Affairs,… 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. ... support in response to emergency situations. + Prepare chart documentation for review and counter signature by the physician. + Determine differential diagnosis. +… more
- Lincoln Financial (Annapolis, MD)
- …as indicated **What we're looking for** * 4 Year/Bachelor's Degree in Nursing * Registered Nurse License - Current, unrestricted license in the state where the ... We are excited to bring on a highly motivated Nurse Disability Consultant to our clinical organization. This position...Trauma , Disability, Workman's comp or case management or Utilization review **Application Deadline** **What's it like… more
- Evolent (Annapolis, MD)
- …focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and procedures ... work with a group of nurses, providing appeal intake review for one dedicated client. They interact with coordinators...Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to company… more
- CareFirst (Baltimore, MD)
- …addition to the required work experience. **Licenses/Certifications Upon Hire Required:** Health Services\ RN - Registered Nurse Active State Licensure and/or ... (MCG) to act as a resource to conduct concurrent review for medical necessity and appropriate level of care...health care costs. We are looking for an experienced Registered Nurse and people leader with UM/CM… more