- CVS Health (Washington, DC)
- …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 (Washington, DC)
- …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 (Washington, DC)
- …(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 (District Of Columbia, DC)
- …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 (Washington, DC)
- …**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
- Immigration and Customs Enforcement (Washington, DC)
- …Manager works under the general supervision of the IHSC Regional Behavioral Health Clinical Consultant within their area of responsibility. The incumbent plans ... of command. Perform other duties and responsibilities as assigned. 16. Utilization review/ management for inpatient behavioral health hospitalization for IHSC.… 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