- AmeriHealth Caritas (Washington, DC)
- …Under the direction of a supervisor, the Clinical Care Reviewer - Utilization Management evaluates medical necessity for inpatient and outpatient services, ... in a fast-paced environment. ;The Clinical Care Reviewer - Utilization Management will also be counted upon...document and assess patient cases. + Strong understanding of utilization review processes, including medical necessity criteria,… more
- Elevance Health (Fairfax, VA)
- RN Utilization Review Nurse (Washington DC...is located at 609 H. Street NE. The **Medical Management Nurse ** is responsible for review ... scope of licensure the District of Columbia is required. **Preferred Qualifications:** + Utilization Management / Review in managed care strongly preferred. +… more
- Zurich NA (Washington, DC)
- …+ Experience in development and implementation of cost containment programs + Case management , utilization review , catastrophic or disability experience + 5 ... AVP, Utilization Review & Pharmacy 123092 Zurich...recruiting and retaining team members. + Drive the performance management process by communicating job expectations, monitoring and evaluating… more
- The Arora Group (Bethesda, MD)
- …Certified Care Managers: Care Manager Certified (CMC) + Experience: + Referral Management / Utilization Management (RM/UM) experience. + Clinical subspecialty ... case-managed patients, throughout the continuum of care. + Conduct training in nurse case management for professional and paraprofessionals personnel, within the… more
- Evolent (Washington, DC)
- …appeals. **What You Bring:** + 1-3 years' experience in clinical Appeals Review or Utilization Management Review as an LPN or LVN is required. + Must ... the culture. **What You'll Be Doing:** The Evolent Appeals Nurse team offers candidates the opportunity to make a...appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and… more
- Ivyhill Technologies LLC (Bethesda, MD)
- …nursing program. Must have three (3) years of clinical nursing experience. Referral Management (RM) and Utilization Management (UM) experience is preferred. ... referral management services for beneficiaries in the Defense Health Network. Registered Nurse will have overall responsibility for timely review of Right of… more
- Sharecare (Washington, DC)
- …total healthcare management and ensure cost effective, appropriate resource utilization and quality outcomes. The Clinical Registered Nurse is also ... the participants and their Primary Care Provider according to the disease management program intervention guidelines. A Clinical Registered Nurse is supervised… more
- Lincoln Financial (Washington, DC)
- …Care, Orthopedics, Coronary Care, , Trauma , Disability, Workman's comp or case management or Utilization review **Application Deadline** **What's it like ... Role at a Glance** We are excited to bring on a highly motivated Nurse Disability Consultant to our clinical organization. This position will be responsible for… 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 ... 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 … more
- HCA Healthcare (Fairfax, VA)
- …you passionate about delivering patient-centered care?** Submit your application for Operating Room Nurse Float Pool position and spend more time at the bedside with ... work to deliver clinical excellence behind the scenes in data science, case management or transfer centers. Unlock your potential at Surgery Ventures! **Job Summary… more
- Highmark Health (Washington, DC)
- …triaging members to appropriate resources for additional support. + Implement care management review processes that are consistent with established industry, ... Nursing **EXPERIENCE** **Required** + 7 years in any combination of clinical, case/ utilization management and/or disease/condition management experience, or… more
- Fresenius Medical Center (Clinton, MD)
- …and acts as the liaison for patient care as per the disease management agreement, including initial and ongoing validation of member eligibility. Facilitate timely ... workup of patients for access management , dialysis services, patient education, hospitalizations, and kidney transplantation as appropriate, and ensures coordination… more
- Trinity Health (Silver Spring, MD)
- …+ Assumes primary supervisory responsibility for the following direct reports: + Manager of Utilization Review and Case Management + Manager of Continuum of ... + Minimum of 2 years leadership experience in case management , utilization review or closely...basis, with the Vice President of Patient Care Services ( Nurse Executive), the Vice President of the Medical Affairs,… 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 ... Team Ivyhill is currently seeking to hire Referral Management (Non- Nurse ) Reviewers to support its...review duties, seeking guidance from the product line nurse (s), and other members of the healthcare team and… more
- Immigration and Customs Enforcement (Washington, DC)
- …Registered Nurse or Physician Assistant/Associate with clinical and case management experience. Minimum four years of clinical experience and two years of ... Service Corps (IHSC). The incumbent will report directly to the Medical Case Management Program Manager (MCMPM). This is a non-supervisory position. This position is… more
- Ivyhill Technologies LLC (Bethesda, MD)
- …nursing 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 Referral Management (RN) Training Manager to support its contract...all incoming RM staff to be able to accurately review referrals utilizing the Specialty Referral Guideline (SRG) compliance… more
- Trinity Health (Silver Spring, MD)
- …experience in the development and management of quality, risk, and utilization review processes. + Strong leadership, communication, and analytical skills. + ... a high level of patient satisfaction and effective resource utilization . + Collaborate with certified nurse midwives,...deliver comprehensive care. + Participate in quality, risk, and utilization review processes. + Supervise and teach… more
- Erickson Living (Springfield, VA)
- …clinical leadership meetings such as Wound Rounds, Clinical Operations Meeting, Utilization Review , and Performance Improvement/Risk Management /Safety ... clinical practice and processes in accordance with the Erickson Senior Living Management Policies and Procedures and nursing standards of practice. + Ownership of… more
- Somatus (Falls Church, VA)
- …and auditing + Ability to work closely with the Director and Clinical Nurse Manager to manage the day-to-day activities and workload of the facility staff, ... feedback in the form of the annual performance evaluation during the performance review process. Obtains feedback and input regarding the staff performance from the… more
- Immigration and Customs Enforcement (Washington, DC)
- … Practitioner/Physician Assistant), preferably in correctional or detention setting. Case management and utilization review experience preferred. ... reports site visit findings to ICE/ERO and IHSC for review and approval of medical compliance findings related to...SKILLS, AND ABILITIES: Must be an Advanced Practice Provider ( Nurse Practitioner/Physician Assistant) or Registered Nurse who… more