- Ascension Health (Baltimore, MD)
- …Provide health care services regarding admissions, case management, discharge planning and utilization review . Responsibilities: + Review admissions and ... planning needs with healthcare team members. + May prepare statistical analysis and utilization review reports as necessary. + Oversee and coordinate compliance… more
- AmeriHealth Caritas (Washington, DC)
- …care, or medical office setting **Licensure** + Current driver's license required + A Registered Nurse (RN) license in the District of Columbia in good standing ... to efficiently document and assess patient cases + Strong understanding of utilization review processes, including medical necessity criteria, care coordination,… more
- Veterans Affairs, Veterans Health Administration (Baltimore, MD)
- …Former EDRP participants ineligible to apply. Responsibilities Duties: Critical Care Registered Nurse (RN) is responsible for providing competent, evidence-based ... equivalent to a bachelor's level degree in Nursing may have opportunity to become registered as a nurse with a state licensing board prior to completion… more
- Ivyhill Technologies LLC (Bethesda, MD)
- …referral management services for beneficiaries in the Defense Health Network. Registered Nurse will have overall responsibility for timely review of Right of ... Ivyhill is currently seeking to hire a Registered Nurse (Non-Practicing) to support its...of Specialty Care Referrals, sustaining up-to-date Specialty Clinic Referral Review tools and booking guidance, complying with Referral and… more
- Ascension Health (Baltimore, MD)
- …job transfer date required. American Heart Association or American Red Cross accepted. + Registered Nurse obtained prior to hire date or job transfer date ... required. Education: + Required professional licensure/certification AND 3 years of experience and 1 year of cumulative leadership experience required. **Additional Preferences** \#ATP **Why Join Our Team** Ascension associates are key to our commitment of… more
- LifePoint Health (Warrenton, VA)
- …Experience* *Required*- Three years of nursing experience. *Preferred*- Experience in utilization review , case management, discharge planning, and clinical ... federal, state or local law./ **Job:** **Nursing* **Organization:** ** **Title:** * Registered Nurse (RN) - Case Manager* **Location:** *Virginia-Warrenton*… more
- Fresenius Medical Center (Hyattsville, MD)
- …all FMS manuals. + Accountable for completion of the Annual Standing Order Review and ICD coding. + Checks correspondence whether electronic, paper or voice mail, ... supporting billing and collection activities. + Responsible for efficient utilization of medication, laboratory, inventory, supplies and equipment to achieve… more
- Fresenius Medical Center (Baltimore, 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
- Evolent (Washington, DC)
- …are applied appropriately. **Qualifications:** + Current, unrestricted state licensure as a Registered Nurse + Associate or Bachelors in Nursing (Must be ... , you will be a key member of the utilization management team. We can offer you a meaningful...a Registered Nurse ) + Strong interpersonal and communication… more
- Sharecare (Washington, DC)
- …to enable individuals with disabilities to perform the essential functions. + Current Registered Nurse multi-state compact license in the state in which they ... utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during their interactions with participants for identification… more
- Johns Hopkins University (Baltimore, MD)
- …team while maintaining patient confidentiality. **Minimum Qualifications** + Master's Degree in Nursing; Registered Nurse license and Certified as a Nurse ... The Department of Emergency Medicine is seeking a **_Sr. Nurse Practitioner_** to work collaboratively within a multidisciplinary health care team. Responsible for… more
- Johns Hopkins University (Baltimore, MD)
- …fluids with blood borne pathogens. **Minimum Qualifications** + Master's Degree in Nursing. + Registered Nurse license and Certified as a Nurse Practitioner. ... The Department of Emergency Medicine is seeking a **_Sr. Nurse Practitioner_** to work collaboratively within a multidisciplinary health care team. Responsible for… more
- Molina Healthcare (Woodbridge, VA)
- **JOB DESCRIPTION** For this position we are seeking a (RN) Registered Nurse who lives in South Carolina, Virginia, Tennessee, North Carolina, or Florida and ... Behavioral health services. Strongly prefer candidates with a background on utilization management or appeals. Excellent computer multi-tasking skills and good… more
- CVS Health (Washington, DC)
- …+ Perform medical necessity reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse with at least 1 year of experience in a hospital ... setting. + A Registered Nurse that holds an active, unrestricted...lower levels of care. + 1+ years' experience in Utilization Review . + CCM and/or other URAC… more
- Amergis (Columbia, MD)
- Salary: $53 / Hour The Registered Nurse - Hospice Case Manager is responsible for providing care, comfort and supportto terminally ill patients. The Registered ... the delivery of hospice patient carein various settings. The Registered Nurse demonstrates the abilityto make clinical...highest level of care. + Inform Team Leader of utilization of other team members, outside agencies, and community… more
- CareFirst (Baltimore, MD)
- …of care and manage health care costs. **We are looking for an experienced Registered Nurse and people leader with UM/CM experience** **living within the ... required work experience. **Licenses/Certifications Upon Hire Required:** Health Services\RN - Registered Nurse Active State Licensure and/or Compact State… more
- Highmark Health (Washington, DC)
- …+ Experience in UM/CM/QA/Managed Care **LICENSES or CERTIFICATIONS** **Required** + United States Registered Nurse (RN) license + Delaware RN license must be ... Inc. **Job Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of health… more
- Erickson Living (Springfield, VA)
- …leadership meetings such as Wound Rounds, Clinical Operations Meeting, Utilization Review , and Performance Improvement/Risk Management/Safety (PI/RM/S) Committee ... (skilled nursing, long term care, assisted living or hospital) is required. + Current Registered Nurse license for the state in which they operate. + Current… more
- Ivyhill Technologies LLC (Bethesda, MD)
- …and able to perform all the duties and requirements of the Referral Registered Nurse and the the RM Reviewers. Requirements Qualified candidate must ... all incoming RM staff to be able to accurately review referrals utilizing the Specialty Referral Guideline (SRG) compliance...be a Licensed Registered Nurse (RN), with an unencumbered active… more
- Sunrise Senior Living (Arlington, VA)
- …of approved college / school of nursing + Maintains a current state license as a Registered Nurse per state regulations. + A minimum of two (2) years' experience ... **If you're currently an ADON, Unit Manager, or Charge Nurse ready to take the next step in your...the highest quality standards for well-being. + Ensures proper utilization of the Resident Care Plan by all team… more