- 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 (Annapolis, MD)
- …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
- Home Depot (Baltimore, MD)
- …and planning function to ensure timely deliveries to stores while ensuring cube utilization ; manage inbound deliveries to ensure on time, on cycle and lead time; ... reduce freight costs whenever possible; audit invoices of carriers on regular basis; review general ledger for all charges dealing with transportation. + 20% Drive… 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 (Washington, DC)
- …understanding of capture processes to win new business including: the gate review process; developing a capture strategy; planning capture milestones, managing a ... and delivery of compliant, responsive, innovative and integrated technical solutions and management approaches that are competitive and cost effective. + Passion and… more
- CareFirst (Baltimore, MD)
- …week. **ESSENTIAL FUNCTIONS:** + Trains staff on standards of practice of Utilization Management and reimbursement methodologies and treatment coding. + Manages ... required work experience. **Experience:** 5 years Experience in a clinical and utilization review roles. 1 year demonstrated progressive leadership experience.… 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 (Annapolis, MD)
- …. 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 (Annapolis, MD)
- …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 (Annapolis, MD)
- …reviewers are supported by Physician clinical review staff (MDs) in the utilization management determination process. **What You Will Be Doing:** + Reviews ... Stay for the culture. **What You'll Be Doing:** Clinical Reviewer , Physical Therapy As a Clinical Reviewer ,...Therapy you will be a key member of the utilization management team. We can offer you… more
- Evolent (Annapolis, MD)
- …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
- Evolent (Annapolis, MD)
- …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 (Annapolis, MD)
- …:** **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
- Elevance Health (Washington, DC)
- …to clients/ members. The medical director provides clinical expertise in all aspects of utilization review and case management . Provides input on the ... means that the medical director is directly involved in Utilization Management and Case Management ....state or territory of the United States when conducting utilization review or an appeals consideration and… more
- Evolent (Annapolis, MD)
- …As a Vascular Surgery, Field Medical Director you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality… more
- Evolent (Annapolis, MD)
- …Doing:** As a Cardiology, Field Medical Director you will be a key member of the utilization management team. We can offer you a meaningful way to make a ... utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality… more
- Ivyhill Technologies LLC (Bethesda, MD)
- …an Associate's Degree and a minimum of 2 years of experience in Utilization Management , Referral Management , Authorization/Denials, or Medical Claims ... to non-network providers to TRICARE Service Center for medical necessity/appropriateness review . + Routinely monitors referral management voicemail to ensure… more
- CareFirst (Baltimore, MD)
- …Active State Licensure and/or Compact State Licensure. **Experience:** 5 years experience in Utilization Management or Case Management at CareFirst BlueCross ... **Resp & Qualifications** **PURPOSE:** The Care Management Supervisor supervises, directs and coordinates the activities...as a resource for the nurses to conduct concurrent review for medical necessity and appropriate level of care… more
- Trinity Health (Silver Spring, MD)
- …of hospitalization, LOC status, LOS management , continued stay decisions, clinical review of patients, utilization review activities, resource ... Accreditation: Maintains knowledge of regulatory and accreditation requirements related to utilization review (UR) LOC and clinical documentation. **5.** Revenue… more
