- 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
- Evolent (Washington, DC)
- …As a Clinical Reviewer, Nurse , you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... Clinical reviewers are supported by Field Medical Directors (MDs) in the utilization management determination process. + Reviews charts and analyzes clinical… 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 ... using a keyboard **Preferred Qualifications** - 1+ years' Case Management experience or discharge planning, nurse navigator...lower levels of care - 1+ years' experience in Utilization Review - CCM and/or other URAC… 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 ... Pharmacy or Oncology.** **Preferred Qualifications** + 1+ years' Case Management experience or discharge planning, nurse navigator...lower levels of care. + 1+ years' experience in Utilization Review . + CCM and/or other URAC… 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
- BAYADA Home Health Care (Falls Church, VA)
- …operations. This individual will be responsible for overseeing the day-to-day management of the agency, ensuring high-quality patient care, regulatory compliance, ... metrics including admission rates, re-hospitalizations, visit productivity, and clinician utilization . + Collaborate with referral sources, physicians, hospitals, and… more
- Fresenius Medical Center (Hyattsville, 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
- Molina Healthcare (Woodbridge, VA)
- …and Behavioral health services. Strongly prefer candidates with a background on utilization management or appeals. Excellent computer multi-tasking skills and ... Medical, or ER unit. **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). To all current Molina… 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
- 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
- Sunrise Senior Living (Arlington, VA)
- …per state regulations. + A minimum of two (2) years' experience in a nurse management position within a skilled nursing environment including hiring staff, ... education institutions * Higher wage rates * Changes in management * Improved health and wellness benefits starting January...**If you're currently an ADON, Unit Manager, or Charge Nurse ready to take the next step in your… 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
- Sunrise Senior Living (Mclean, VA)
- …per state regulations. + A minimum of two (2) years' experience in a nurse management position within a skilled nursing environment including hiring staff, ... education institutions * Higher wage rates * Changes in management * Improved health and wellness benefits starting January...the highest quality standards for well-being. + Ensures proper utilization of the Resident Care Plan by all team… more
- KBR (Arlington, VA)
- …compliance in meeting care goals. + Knowledge and skill in using pre-established utilization review criteria recognize and report actual or potential quality and ... risk management issues in order to improve practice, and ensure...full , active, and unrestricted license as a Registered Nurse or Licensed Clinical Social Worker in one of… more
- KBR (Washington, DC)
- …compliance in meeting care goals. + Knowledge and skill in using pre-established utilization review criteria recognize and report actual or potential quality and ... risk management issues in order to improve practice, and ensure...Management Certification, American Case Manager Association, or American Nurse Credentialing Center, or shall obtain the certification within… 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 ... organizational and department goals + You will utilize talent review data for pipeline development + You will foster...and/or experience + Currently licensed as a registered professional nurse in the state in which he or she… more