- Elevance Health (Washington, DC)
- **Clinical Operations Medical Director** ** Utilization Management of Medical Oncology Benefits** **Carelon Benefits Management ** **$20,000 Sign On Bonus** ... members and providers. **Job Summary:** + Perform physician-level case review , following initial nurse review ,...maintain knowledge of relevant policies and regulations pertaining to utilization review of oncology care. + Participate… more
- Lincoln Financial Group (Washington, DC)
- …Experience and/or proficiency with Disability Management (STD/LTD) knowledge, Workers Compensation, Utilization Review and/or nurse case management ... Role at a Glance** We are excited to bring on a highly motivated Nurse Disability Consultant to our clinical organization. This position will be responsible for… more
- Humana (Annapolis, MD)
- … management personnel and oversee all utilization management functions, including inpatient admissions, concurrent review , prior authorization, and ... put health first** Humana Healthy Horizons in Virginia is seeking a Manager, Utilization Management (Behavioral Health) who will utilize their clinical skills to… more
- The Arora Group (Bethesda, MD)
- …Certified Care Managers: Care Manager Certified (CMC) + Experience: + Referral Management / Utilization Management (RM/UM) experience. + Clinical subspecialty ... case-managed patients, throughout the continuum of care. + Conduct training in nurse case management for professional and paraprofessionals personnel, within the… more
- Elevance Health (Hanover, MD)
- …**How you will make an impact:** + Develops, maintains and enhances the claims review process. + Assists management with developing unit goals, policies and ... ** Nurse Audit Lead** **Supports the Carelon Payment Integrity...responsible for identifying, monitoring, and analyzing aberrant patterns of utilization and/or fraudulent activities by health care providers through… more
- Johns Hopkins University (Columbia, MD)
- The Department of Emergency Medicine is seeking a **_Sr. Nurse Practitioner_** to work collaboratively within a multidisciplinary health care team. This Position ... and appropriate measures in acute and chronic illness. The Sr. Nurse practitioner will direct supervision from appropriate licensed physician as designated.… more
- KBR (Washington, DC)
- …compliance in meeting care goals. + Knowledge and skill in using pre-established utilization review criteria recognize and report actual or potential quality and ... by a recognized certifying organization, ie Commission for Case Management Certification or America n Nurse Credentialing...for Case Management Certification or America n Nurse Credentialing Center or American Nurse Credentialing… more
- Fresenius Medical Center (Lanham Seabrook, MD)
- …auditing activities. + Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. + Manages clinic ... financials including efficient utilization of supplies or equipment and regular profits and...of supplies or equipment and regular profits and loss review . + Responsible for all required network reporting and… more
- Serco (Washington, DC)
- …experience in a supervisory/managerial role in the health insurance industry, a utilization review firm, or another health care claims processing organization ... from a variety of provider types; + Extensive experience performing medical review and/or utilization /QA reviews; + Education, Licensure, and Certification: +… more
- Marriott (Washington, DC)
- …with Claims department regarding case management . + Collaborate with UNM on utilization review issues. + Refer catastrophic cases in coordination with claims ... claims most likely to benefit from case management to meet jurisdictional needs. ** Utilization Review ** + Provide initial clinical review in order to… more
- Fairfax County Sheriff's Office (Fairfax, VA)
- …the timely delivery of services and supports to children, youth, and families? The Utilization Review Analyst (URA) position will allow you the opportunity to ... services are therapeutically and financially appropriate. This is accomplished through the utilization review process by collecting and analyzing case specific… more
- CenterWell (Annapolis, MD)
- …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and ... requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking...and reliable transportation. + Two years as a Registered Nurse with at least one-year of management … more
- Sunrise Senior Living (Silver Spring, MD)
- …per state regulations. + A minimum of two (2) years' experience in a nurse management position within a skilled nursing environment including hiring staff, ... The Director of Nursing Services is responsible for providing leadership and management to the skilled nursing operations. Responsible for planning, organizing and… 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