- CVS Health (Annapolis, MD)
- …all with heart, each and every day. **Position Summary:** The ** Utilization Management Clinical Nurse Consultant - Prior Authorization** utilizes ... internal and external constituents in the coordination and administration of the utilization /benefit management function. + Gathers clinical information and… more
- CVS Health (Annapolis, MD)
- …internal and external constituents in the coordination and administration of the utilization /benefit management function. + Gathers clinical information and ... skills to coordinate, document, and communicate all aspects of the utilization /benefit management program. + Applies critical thinking and knowledge in… more
- CVS Health (Annapolis, MD)
- …(UM) Nurse Consultant . As a Utilization Management Nurse Consultant , you will utilize clinical skills to coordinate, document and communicate all ... clinical records. **Key Responsibilities of the UM Nurse Consultant ** (Includes but is not limited to) + Reviews...practice experience as an RN required. + 2+ Years Utilization Management experience. + Must be willing… more
- CVS Health (Annapolis, MD)
- …Must have active current and unrestricted RN licensure in state of residence - Utilization Management is a 24/7 operation and work schedules will include ... in med surg or specialty area - Managed Care experience preferred, especially Utilization Management - Preference for those residing in EST zones **Anticipated… more
- CareFirst (Baltimore, MD)
- …**Experience:** 5 years experience in business development, operational technology support, Utilization Management (UM) operations, Clinical Product ... role will focus specifically on optimizing end-to-end business processes within Utilization Management . **ESSENTIAL FUNCTIONS:** + Provide deep subject matter… more
- Cardinal Health (Baltimore, MD)
- …a highly regulated industry + Previous sales experience selling to physicians, clinical end-users, materials management , and C-suite desired + Strong preference ... Job Description **Senior Consultant , Product Sales Specialist - NPHS** **The territory covers Pennsylvania (Philadelphia, Pittsburgh and Allentown), Maryland… more
- Highmark Health (Annapolis, MD)
- …**Job Description :** **JOB SUMMARY** Dynamic and results-oriented Pharmacy Benefit Consultant , serving as the client-facing expert, driving growth and retention of ... Consultation: Provide in-depth pharmacy benefit expertise, offering strategic guidance, clinical recommendations, and solutions tailored to individual client needs.… more
- CareFirst (Baltimore, MD)
- …psychiatric setting. **Preferred Qualifications:** + 2 years experience in Medical Review, Utilization Management or Case Management at CareFirst BlueCross ... **Resp & Qualifications** **PURPOSE:** The Clinical Appeals Nurse completes research, basic analysis, and...regulatory and accreditation requirements, understanding of appeals process and utilization management , and systems software used in… more
- CareFirst (Baltimore, MD)
- …or similar clinical experience OR 5 years experience in Medical Review, Utilization Management or Case Management at CareFirst BlueCross BlueShield, or ... **Resp & Qualifications** **PURPOSE:** The Clinical Appeals Supervisor directs and coordinates the accurate...regulatory and accreditation requirements, understanding of appeals process and utilization management , and systems software used in… more
- Trinity Health (Silver Spring, MD)
- …appropriate utilization /level of care (LOC), length of stay (LOS) management , patient flow/throughput management , appropriate clinical documentation, and ... LOC status, LOS management , continued stay decisions, clinical review of patients, utilization review activities,...planning (DP) advise and quality issues. Functions as a consultant and resource to other Physician Advisors and primary… more
- Veterans Affairs, Veterans Health Administration (Linthicum Heights, MD)
- …may conduct psychiatric evaluations, develop treatment plans, implement treatment, and provide clinical management for a variety of complex mental health ... studies and/or for adjunctive psychosocial interventions. Perform duties as a practitioner and consultant in Psychiatry within a variety of clinical settings but… more
- Johns Hopkins University (Baltimore, MD)
- …of acute and long-term effects of radiation and provides accurate and timely management for such side effects. + Provides education to patient and family members ... + Conducts telehealth visits as appropriate for follow-up care, symptom management , or triage, ensuring timely communication and documentation in the EMR.… more