- Elevance Health (Washington, DC)
- …degrees of medical complexity and acuity. Participates in case and/or utilization management execution/decision making for managed member populations. Primary ... II HCMS is responsible for managing a team of physical and/or behavioral health practitioners in the development, implementation, and coordination of a comprehensive… more
- Humana (Washington, DC)
- …us put health first** This is a non-exempt position with responsibility for utilization management and clinical decision-making as outlined in the Autism Care ... Responsibilities** Tasks include, but are not limited to: **70%** : Performing utilization management activities for assigned areas. Ensures full compliance with… more
- The Arora Group (Bethesda, MD)
- …Managers: Care Manager Certified (CMC) + Experience: + Referral Management / Utilization Management (RM/UM) experience. + Clinical subspecialty experience ... certifications: + Commission for Case Manager Certification Certified Case Manager (CCM) + Certification of Disability Management Specialists Commission:… more
- CenterWell (Washington, DC)
- …Coordinate quality improvement activities to address high risk, high-utilizers/high-cost patient management through the utilization of the 5M's framework as ... ER visits, readmissions, total cost of care, and reducing acute care utilization ). * Familiarity in integrated care management programs with primary… more
- Elevance Health (Hanover, MD)
- …provider assignments and oversight of daily activities and provide feedback to manager on performance management , day-to-day training, guidance, and workflow of ... A proud member of the Elevance Health family of companies, Carelon Behavioral Health, formerly Beacon Health Options, offers superior clinical mental health and… more
- Elevance Health (Arlington, VA)
- …The **Case Manager (Managed Care Coordinator)** is responsible for overall management of member's individual service plan within the scope of position, as ... **Case Manager ** **Location :** This is a hybrid role...member of the Elevance Health family of companies, Carelon Behavioral Health, formerly Beacon Health Options, offers superior clinical… more
- Centene Corporation (Arlington, VA)
- …Associate's Degree in nursing** **Candidate Experience:** Required 2+ years of experience in utilization management and/or case management in a hospital or ... and facilities/agencies. + Coordinates community resources, with emphasis on medical, behavioral , and social services. Applies case management standards,… more
- Ford Motor Company (Washington, DC)
- …is best-in-class. **In this position ** The Accessories eCommerce Merchandising Manager is responsible for deeply understanding customer needs and optimizing the ... business value daily by pulling, analyzing, and translating web analytics and behavioral data into actionable insights to enhance sales, conversion, and customer… more
- CenterWell (Washington, DC)
- …health and full-risk frameworks, including patient engagement, clinical professional skillsets, utilization management , care management , clinical information ... the complex needs of seniors and improve health outcomes and avoidable utilization (eg, palliative care, post-acute care, transitions of care) at a population… more
- CenterWell (Washington, DC)
- …optimal patient care, high quality health outcomes, and improved cost and utilization in pharmacy-related care, and serve as a national clinical program leader ... This role reports to the National Director, High Risk Patient Management . Responsibilities will include: + Lead comprehensive clinical pharmacy service development,… more
- Highmark Health (Washington, DC)
- …performance and compliance monitoring. This position will continuously engage Procurement Management to review performance and key performance indicators and take a ... functional business clients to drive best practice adoption, optimized system utilization and continuous process improvement outcomes. + Develop and maintain… more
- Fairfax County Sheriff's Office (Fairfax, VA)
- …waivers (service modifications, renewals, etc.) including submissions in WaMS (Waiver Management System). Participates in record and utilization reviews, assume ... of client needs (including treatment modalities, intervention techniques, behavior management , independent living skills, supportive counseling, family education, crisis… more
- Sharecare, Inc. (Washington, DC)
- …other members of the health care team to support appropriate total healthcare management and ensure cost effective, appropriate resource utilization and quality ... with the participants and their Primary Care Provider according to the disease management program intervention guidelines. An RN is supervised by an Operations … more
- CenterWell (Washington, DC)
- …to ensure enrollment success, identifying member education opportunities to drive maximum utilization of available resources, and directing patients on the use of ... care to seniors, including wellness visits, physical exams, chronic condition management , screenings, minor injury treatment and more. Our unique care model… more