- Battelle Memorial Institute (Arlington, VA)
- …as a case manager by a recognized certifying organization, ie, Commission for Case Management Certification or American Nurse Credentialing Center + At least two ... Research and Analytics (HRA) business line is seeking a highly motivated, full-time ** Nurse Case Manager** to join our team in support of our government customer,… more
- Humana (Washington, DC)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- Humana (Washington, DC)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- Cognizant (Washington, DC)
- …background - Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management experience with managed health care plan . 3 years' experience ... Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced...care revenue cycle or clinic operations . Experience in utilization management to include Clinical Appeals and… more
- AmeriHealth Caritas (Washington, DC)
- **$5,000.00 SIGN ON BONUS** **Role Overview** Our Utilization Management Reviewers evaluate medical necessity for inpatient and outpatient services, ensuring ... in the least restrictive and most effective manner. The Utilization Management Reviewer must maintain a strong...3 years of diverse clinical experience as a Registered Nurse in an Intensive Care Unit (ICU), Emergency Department… more
- CVS Health (Washington, DC)
- …experience working within the mental health system. + Previous experience with utilization management . + Ability to collaborate with various internal ... clinical skills to coordinate, document, and communicate all aspects of the utilization /benefit management program. + Conduct clinical reviews for adult… more
- Sharecare (Washington, DC)
- …appropriate resource utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during their interactions with participants ... for everyone. To learn more, visit www.sharecare.com . **Job Summary:** The Disease Management Nurse has the responsibility for supporting the goals and… more
- Immigration and Customs Enforcement (Washington, DC)
- …health facility surveyors and in collaboration with the IHSC Medical Quality Management Unit. SUPERVISORY CONTROLS: The Clinical Senior Nurse Specialist, Medical ... clinical and administrative nursing support, and collaborating with the IHSC Chief Nurse in the Nursing Services Unit to implement initiatives aimed at enhancing… 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 ... Abuse or Maternity/ Obstetrics experience. **Preferred Qualifications** + 1+ years' Case Management experience or discharge planning, nurse navigator or nurse… more
- Erickson Living (Springfield, VA)
- …leadership meetings such as Wound Rounds, Clinical Operations Meeting, Utilization Review, and Performance Improvement/Risk Management /Safety (PI/RM/S) Committee ... by Erickson Senior Living Join our team as the Nurse Manager, RN also known as the Clinical Manager!...and processes in accordance with the Erickson Senior Living Management Policies and Procedures and nursing standards of practice.… 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 a Registered Nurse (Non-Practicing) to support its contract with the Integrated Referral Management and Appointing Center… more
- Highmark Health (Washington, DC)
- …Nursing **EXPERIENCE** **Required** + 7 years in any combination of clinical, case/ utilization management and/or disease/condition management experience, or ... within the first 6 months of employment. **Preferred** + Certification in utilization management or a related field + Certification in Case Management … more
- Elevance Health (Ashburn, VA)
- …criteria._** The **Telephonic Nurse Case Manager II** is responsible for care management within the scope of licensure for members with complex and chronic care ... **Telephonic Nurse Case Manager II** **Location:** This role enables...claims or service issues. + Assists with development of utilization /care management policies and procedures. **Minimum requirements:**… more
- Elevance Health (Washington, DC)
- …with providers, claims or service issues. + Assists with development of utilization /care management policies and procedures, chairs and schedules meetings, as ... ** Nurse Case Manager Sr** **Location:** Washington, DC. This... Case Manager Sr** will be responsible for care management within the scope of licensure for members with… more
- Trinity Health (Silver Spring, MD)
- **Employment Type:** Full time **Shift:** Day Shift **Description:** **Job Title:** Nurse Supervisor- IMC **Employment** **Type:** Full time / Day Shift ... Program + **Location:** Holy Cross Health, Silver Spring, MD **Description:** The Nurse Supervisor is a designated clinical leader for a patient care area… more
- Trinity Health (Silver Spring, MD)
- …high-quality care to patients with complex renal needs. As the designated Nurse Supervisor, you'll coordinate staffing, resource management , and clinical ... **Employment Type:** Full time **Shift:** Day Shift **Description:** **Clinical Nurse Supervisor - Dialysis** **Location: Holy Cross Hospital** **Employment Type:… more
- Trinity Health (Silver Spring, MD)
- …Sign-on Bonus & More** **Position Overview** As a Home Health Registered Nurse , you'll provide in-home skilled nursing care to patients by developing personalized ... exceptional coverage and real savings that make a difference. + **Supportive Leadership** Our management team is here to help you succeed every step of the way. +… more
- Evolent (Washington, DC)
- …responsible for support and assistance for all cardiology administrative and clinical utilization management and quality improvement functions under the auspices ... is 11:30-8:00 eastern** **OTHER SKILLS and ABILITIES:** Strong clinical, management , communication, and organizational skills. Demonstrated leadership skills Analytic… 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 contract with the Integrated Referral Management and… more
- Trinity Health (Silver Spring, MD)
- …protocols. + Demonstrate a high level of patient satisfaction and effective resource utilization . + Collaborate with certified nurse midwives, nurse ... 2 years of supervisory experience. + Demonstrated experience in the development and management of quality, risk, and utilization review processes. + Strong… more
