- Humana (Annapolis, MD)
- …Degree or BSN degree. + Minimum 3 years of experience in NCQA Health Plan Accreditation and/or Utilization Management + Exceptional attention to detail. + ... help us put health first** We are seeking a Senior Accreditation Professional who will work in...on NCQA accreditation standards, especially related to Utilization Management and/or Behavioral Health; MED-Deeming … more
- Johns Hopkins University (Baltimore, MD)
- …and supporting the well-being of a diverse community of learners. The Senior Mental Health Services Clinician Initial Consultation Team Lead will provide direct ... care options. All MHS clinicians work collaboratively with psychiatry, case management , occupational therapy, primary care, and health promotion staff to provide… more
- Marriott (Bethesda, MD)
- …**Schedule** Full Time **Located Remotely?** Y **Position Type** Management This is a temporary position. The Senior ... 8+ years of experience in information security, focusing on Certification and Accreditation (C&A), Risk Management Framework (RMF), and security controls… more
- Evolent (Annapolis, MD)
- …selecting health plans or regions, assuming overall accountability for utilization management while working in conjunction with the Senior Medical Director. ... , you will be a key member of the utilization management team. We can offer you... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more
- Humana (Annapolis, MD)
- …a part of our caring community and help us put health first** The Senior Utilization Management Behavioral Health Professional utilizes behavioral health ... and communication of medical services and/or benefit administration determinations. The Senior Utilization Management Behavioral Health Professional work… more
- Evolent (Annapolis, MD)
- …selecting health plans or regions, assuming overall accountability for utilization management while working in conjunction with the Senior Medical Director. ... the mission. Stay for the culture. **What You'll Be Doing:** **Cardiovascular Utilization Management Reviewer (Interventional Cardiologist)** Are you ready to… more
- Evolent (Annapolis, MD)
- …selecting health plans or regions, assuming overall accountability for utilization management while working in conjunction with the Senior Medical Director. ... Director you will be a key member of the utilization management team. We can offer you... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more
- Evolent (Annapolis, MD)
- …Doing:** Job Description As a FMD, Radiology you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. +… more
- DCCA (Annapolis Junction, MD)
- …throughout the systems life cycle phases: Concept, Development, Production, Utilization , Support, and Retirement. Interacts with the Government regarding Systems ... conflicts. Communicates with other program personnel, government overseers, and senior executives. Responsibility for the technical integrity, quality, and… more
- Evolent (Annapolis, MD)
- …members and providers + Appropriately identifies and refers quality issues to the Senior Director of Medical Management or Medical Director. + Appropriately ... policies + Creates adverse determination notifications that meet all accreditation , State, and Federal criteria + Uses Plain Language...identifies potential cases for Care Management programs + Communicates appropriate information to other staff… more
- Bowman (Towson, MD)
- …completed using advanced techniques and principles and is reviewed by more senior staff to ensure application of sound professional judgement. Review work produced ... construction. + Review project close-out documentation (O&M Manuals). + Maintain utilization targets. + Communicate effectively with client, internal project team,… more