- Parexel (Washington, DC)
- …mitigations and drive resolution with cross-functional stakeholders as part of the Risk Management Plan. + Review and analyze metrics to derive meaningful ... Leadership:** + Manage and coordinate the integration and utilization of all ancillary systems. + Highlight issues/risks to...project-level resourcing of staff and staff assignments. + Regularly review and update Data Management resources to… more
- Luke Staffing (Bethesda, MD)
- …tasks as assigned (eg on call duties). . Participate in the clinic quality assurance, utilization review , risk management , and peer review activities. ... Contract HCW shall demonstrate skills in interviewing, examination, assessment, and management of patients with general medical and surgical health problems.… more
- LifeBridge Health (Randallstown, MD)
- …Case Management Certification (CCM) within 3 years Must have Utilization Review experience #CareerPriority Additional Information Who We Are: LifeBridge ... Bonus Potential: 6,000 Randallstown, MD NORTHWEST HOSPITAL NW CARE MANAGEMENT Part-time w/Weekend Commitment - Day/Night rotation - Rotating-7am-730pm/7pm-730am RN… more
- Washington Metropolitan Area Transit Authority (Alexandria, VA)
- Senior Financial Management Analyst - Payroll Job ID: 250923 Location: VA - Metro Bldg At Eisenhower Full/Part Time: Full-Time Posting Open-Close 10/10/2025 - ... 10/19/2025 Union NRP Regular/Temporary: Regular **Job Description** **Senior Financial Management Analyst ? Payroll Marketing Statement:** The Washington Metropolitan… more
- Somatus (Mclean, VA)
- …+ Travel (up to 25%) to local renal care providers for quality oversight and utilization review collection + Other duties as assigned. _Please note this job ... and policies of Somatus + Assist Directors of Quality on quality and utilization audits as assigned, including targeted audits as requested by the Director. +… more
- CBRE Government and Defense Services (Reston, VA)
- …Summary** The Director of Operations will be responsible for providing regional management and oversight of aP&L of +$30M of design-build and design-bid-build ... government personnel. Negotiate contracts and bids with vendors and subcontractors. Review jobsite monthly reports and evaluate performance and compliance and lead… more
- Battelle Memorial Institute (Fort Belvoir, VA)
- …programs, with additional applications in military engineering, DoD installation management , and USACE projects. **Deliverable:** The primary deliverable for this ... file sizes, and high utility in operational contexts. **Responsibilities** + Review scientific literature to identify and implement appropriate research methods. +… more
- Red River (Chantilly, VA)
- …to lead a portfolio of managed services accounts within the Property Management and Manufacturing verticals. Proven leader who thrives under scrutiny, takes full ... and grow a portfolio of SMB to enterprise-level accounts within Property Management and Manufacturing vertical. . Drive vertical strategy execution, aligning Red… more
- Battelle Memorial Institute (Chantilly, VA)
- …The **Vice President, Cyber Business Line** is responsible for the organization, management , and business performance of Battelle's cyber business portfolio. The VP ... decision processes; establish pricing policy and practices. + Drive effective project management to ensure all projects are scoped, expensed, and delivered as… more
- Zeiders Enterprises, Inc (Woodbridge, VA)
- …employee of Zeiders responsible for overseeing workforce planning and management processes, including forecasting staffing needs, scheduling service delivery within ... partners and government customers to meet program objectives through resource management . In addition, they will provide outcome-based metrics to showcase the… more
- CBRE Government and Defense Services (Annapolis, MD)
- …or other systems as directed. + Monitor and report performance metrics, labor utilization , and material usage to support compliance and invoicing. + Enforce safety ... FFP contract. + Assist with budget tracking, material procurement, and inventory management . + Respond to emergencies and manage after-hours calls or escalations as… more
- CareFirst (Baltimore, MD)
- …week. **ESSENTIAL FUNCTIONS:** + Trains staff on standards of practice of Utilization Management and reimbursement methodologies and treatment coding. + Manages ... required work experience. **Experience:** 5 years Experience in a clinical and utilization review roles. 1 year demonstrated progressive leadership experience.… more
- CVS Health (Annapolis, MD)
- …members. **Position Summary** The Associate Manager is responsible for oversight of Utilization Management staff. This position is responsible for the ... team maintains compliance and privacy practices. + Oversees the implementation of utilization management services for assigned area + Implements clinical… more
- AmeriHealth Caritas (Washington, DC)
- …BONUS** **Role Overview:** Under the direction of a supervisor, the Clinical Care Reviewer - Utilization Management evaluates medical necessity for inpatient ... overtime, and weekends based on business needs. **Responsibilities:** + Conduct utilization management reviews by assessing medical necessity, appropriateness of… more
- Humana (Annapolis, MD)
- …MDS Coordinator or discharge planner in an acute care setting + Previous experience in utilization management / utilization review for a health plan or ... of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination,… more
- Cognizant (Washington, DC)
- …. Educational background - Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management experience with managed health care plan . 3 years' ... as well as timely filing deadlines and processes. . Review clinical denials including but not limited to referral,...care revenue cycle or clinic operations . Experience in utilization management to include Clinical Appeals and… more
- Humana (Washington, DC)
- …put health first** The UM Administration Coordinator contributes to administration of utilization management . The UM Administration Coordinator 2 performs varied ... new systems (proficient to advanced) **Preferred Qualifications** + Experience with Utilization Review and/or Prior Authorization, preferably within a managed… more
- Evolent (Washington, DC)
- …Reviewer , Interventional Pain Management , you will be a key member of the utilization management team. We can offer you a meaningful way to make a ... Will Be Doing:** + Serve as the Physician Clinical Reviewer for Interventional Pain Management , reviewing cases... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more
- Humana (Washington, DC)
- …. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial ... their daily work. The Medical Director's work includes computer-based review of moderately complex to complex clinical scenarios, ...with prior experience participating in teams focusing on quality management , utilization management , case … more
- Humana (Annapolis, MD)
- …The Care Management Support Assistant 2 contributes to administration of care management , utilization management and daily operations. The ACD RC duties ... authorizations. + Coordinates authorizations with Autism Services Navigators and Utilization Management according to established HUMANA GOVERNMENT BUSINESS… more
