- Humana (Annapolis, MD)
- …community and help us put health first** Full-Time, Remote Telephonic opportunity The Utilization Management Nurse 2 utilizes clinical nursing skills to ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...appropriate courses of action. As a Utilization Management RN working on the OneHome/ Home Solutions… more
- Humana (Annapolis, MD)
- …a part of our caring community and help us put health first** The Weekend 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 (Annapolis, MD)
- **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
- CareFirst (Baltimore, MD)
- …week. **ESSENTIAL FUNCTIONS:** + Trains staff on standards of practice of Utilization Management and reimbursement methodologies and treatment coding. + Manages ... expected to work a portion of their week from home and a portion of their week at a...medical practices and insurance benefit structures. + Proficient in utilization management processes, standards, and managed care.… more
- Trinity Health (Silver Spring, MD)
- …MD Area** **Position Overview - Day 1 Benefits, 10k Sign-on Bonus & More** As a Home Health Registered Nurse , you'll provide in- home skilled nursing care to ... **Employment Type:** Full time **Shift:** **Description:** **Holy Cross Home Care Team is looking for a Fu**...savings that make a difference. + **Supportive Leadership** Our management team is here to help you succeed every… more
- Johns Hopkins University (Baltimore, MD)
- …guidelines of the department and institution and in accordance with the Nurse Practitioner-Physician Written Agreement required and approved by the State of Maryland ... and the Nurse Practice Act of the State of Maryland. Is...long-term effects of radiation and provides accurate and timely management for such side effects. + Provides education to… more
- CVS Health (Annapolis, MD)
- …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
- Lincoln Financial (Annapolis, MD)
- …and/or proficiency with Disability Management (STD/LTD) knowledge, Workers Compensation, Utilization Review and/or nurse case management preferred skills ... **Alternate Locations:** Work from Home **Work Arrangement:** Remote : Work at ...We are excited to bring on a highly motivated Nurse Disability Consultant to our clinical organization. This position… more
- Evolent (Annapolis, MD)
- …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and ... Be Doing:** + Practices and maintains the principles of utilization management and appeals management ...all employees have the following technical capability at their home : High speed internet over 10 Mbps and, specifically… 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
- Fresenius Medical Center (Clinton, MD)
- …and acting on adverse events and action thresholds. + Oversees facility's Home Therapies Program if applicable. + Accountable for compliance with all applicable ... and acts as the liaison for patient care as per the disease management agreement, including initial and ongoing validation of member eligibility. Facilitate timely… more
- Trinity Health (Silver Spring, MD)
- …Type:** Part time **Shift:** Weekend Shift **Description:** **Position Purpose:** Our Home Care RNs (Primary Care Nurses) provides primary nursing care to ... home based care patients as ordered by the physician,...and LPNs as needed. Provides therapeutic intervention, overall care management and achievement of top decile client outcomes and… more
- CareFirst (Baltimore, MD)
- …in addition to the required work experience. **Experience:** 3 years Care Management , Discharge Coordination, Home Health, Utilization Review, Disease ... **Resp & Qualifications** **PURPOSE:** The Inpatient Management Onsite Care Management Supervisor will direct and coordinate the activities of Onsite Care … more
- CareFirst (Baltimore, MD)
- …years clinically related experience working in Care Management , Home Health, Discharge Coordination and/or Utilization Review. **Preferred Qualifications:** ... the timely and smooth transition from inpatient care to home or other levels of care. Utilizing experience and...of care. Utilizing experience and skills in both case management and utilization management including… more
- CareFirst (Baltimore, MD)
- …years clinically related experience working in Care Management , Home Health, Discharge Coordination and/or Utilization Review. **Preferred Qualifications:** ... the timely and smooth transition from inpatient care to home or other levels of care. Utilizing experience and...of care. Utilizing experience and skills in both care management and utilization management , the… more
- CareFirst (Baltimore, MD)
- …5 years clinically related experience working in Care Management , Home Health, Discharge Coordination and/or Utilization Review. **Preferred Qualifications** ... the timely and smooth transition from inpatient care to home or other levels of care. Utilizing experience and...of care. Utilizing experience and skills in both case management and utilization management , the… more
- CareFirst (Baltimore, MD)
- …or Washington. **Experience:** 5 years clinically related experience working in Care Management , Discharge Coordination, Home Health, Utilization Review, ... **PURPOSE:** This position will support the Maryland government programs care management team, specifically the Medicare Advantage line of business. The Care… more
- CareFirst (Baltimore, MD)
- …medical-surgical or similar clinical experience OR 5 years' experience in Medical Review, Utilization Management or Case Management at CareFirst BlueCross ... expected to work a portion of their week from home and a portion of their week at a...regulatory and accreditation requirements, understanding of appeals process and utilization management , and systems software used in… more
- Sharecare (Annapolis, MD)
- …/ new hire plan selection, claims issues, ID card issues, grievances/appeals, utilization management (UM) status, including but not limited to medical, ... + Claims adjustments + Grievances and appeals submissions + Utilization management intake or status + Complex...and second opinion. + Referring members to Clinical Advocates ( Nurse ) for conditions that require clinical care and case… more
- CareFirst (Baltimore, MD)
- …or GED **Experience:** 5 years clinically related experience working in Care Management , Discharge Coordination, Home Health, Utilization Review, Disease ... in nursing + CCM/ACM or other RN Board Certified certification in case management . Federal Employee Program (FEP) Book of Business (ONLY): Must have CCM/ACM or… more