- CVS Health (Annapolis, MD)
- …live in any state. There is no travel expected with this position. As a Utilization Management Nurse Consultant, you will utilize clinical skills to ... make health care more personal, convenient and affordable. This Utilization Management (UM) Nurse Consultant...Word, Excel, Outlook) Preferred Qualifications: - 1+ years' experience Utilization Review experience - 1+ years' experience… more
- Elevance Health (Hanover, MD)
- **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
- 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
- Ascension Health (Baltimore, MD)
- …leadership and Sr Dir of CM as appropriate * Performs other duties as assigned Utilization Management : + Ensures integration of utilization management ... initiatives. + Develops systems and processes for prospective, concurrent and retrospective utilization review for all self-funded and fully insured clients to… more
- CareFirst (Owings Mills, MD)
- …in mental health, psychiatric setting. **Preferred Qualifications:** + 2 years experience in Medical Review , Utilization Management or Case Management at ... of regulatory and accreditation requirements, understanding of appeals process and utilization management , and systems software used in processing appeals.… 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
- Johns Hopkins University (Baltimore, MD)
- The Department of Emergency Medicine is seeking a **_Sr. Nurse Practitioner_** to work collaboratively within a multidisciplinary health care team. Responsible for ... support in response to emergency situations. + Prepare chart documentation for review and counter signature by the physician. + Determine differential diagnosis. +… more
- Fresenius Medical Center (Baltimore, MD)
- …and acts as the liaison for patient care as per the disease management agreement, including initial and ongoing validation of member eligibility. Facilitate timely ... workup of patients for access management , dialysis services, patient education, hospitalizations, and kidney transplantation as appropriate, and ensures coordination… 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
- CareFirst (Baltimore, MD)
- …welcome. **Knowledge, Skills and Abilities (KSAs)** + Knowledge of NCQA requirements of utilization review , Case Management standards and guidelines, appeal ... Corporate Strategic Plan through direction of the Clinical Medical Claims Review , Medical Underwriting, Medical Policy, Clinical Appeals and Analysis programs and… more
- Marriott (Annapolis, MD)
- …with Claims department regarding case management . + Collaborate with UNM on utilization review issues. + Refer catastrophic cases in coordination with claims ... **Schedule** Full-Time **Located Remotely?** Y **Relocation?** N **Position Type** Management **JOB SUMMARY** The Nurse CARE Manager...from case management to meet jurisdictional needs. Utilization Review + Provide initial clinical … more
- Ascension Health (Baltimore, MD)
- …functions, including but not limited to: Access Authorization and pre-certification, utilization review and denial management , CareCoordination, ... specialist for staff in the areas of utilization criteria, appeal and review process, and case management system documentation. + Develop staff schedule and… more
- CareFirst (Baltimore, MD)
- …Licensure. **Experience:** 3 years Care Management , Discharge Coordination, Home Health, Utilization Review , Disease Management or other direct patient ... 5 years Care Management , Discharge Coordination, Home Health, Utilization Review , Disease Management or other direct patient care experience… 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
- CareFirst (Baltimore, MD)
- …working in Care Management , Home Health, Discharge Coordination and/or Utilization Review . **Licenses/Certifications Upon Hire Required:** RN - Registered ... of care utilizing experience and skills in both case management and utilization management including...care. Applies sound clinical knowledge and judgment throughout the review process. Follows member benefit contracts to assist with… more
- Highmark Health (Annapolis, MD)
- …member is responsible for building relationships, engaging clinicians, educating on Utilization Management policies and processes, developing workflows and ... or healthcare consulting in provider setting. + 3 years of experience in utilization management /care management /QA/managed care **Preferred** + 3 years… more
- CareFirst (Baltimore, MD)
- …related experience working in Care Management , Discharge Coordination, Home Health, Utilization Review , Disease Management or other direct patient care ... and/or social determinant of health needs. Engage members and providers to review and clarify treatment plans ensuring alignment with medical benefits and policies… more
- CareFirst (Baltimore, MD)
- …related experience working in Care Management , Discharge Coordination, Home Health, Utilization Review , Disease Management , or other direct patient care ... determinant of health needs. Engage members and providers to review and clarify treatment plans ensuring alignment with medical...CCM/ACM or other RN Board Certified certification in case management . Incumbents not certified at the time of hire… more
- CareFirst (Baltimore, MD)
- …related experience working in Care Management , Discharge Coordination, Home Health, Utilization Review , Disease Management or other direct patient care ... and/or social determinant of health needs. Engage members and providers to review and clarify treatment plans ensuring alignment with medical benefits and policies… more
- CareFirst (Baltimore, MD)
- …related experience working in Care Management , Discharge Coordination, Home Health, Utilization Review , Disease Management or other direct patient care ... and/or social determinant of health needs. Engage members and providers to review and clarify treatment plans ensuring alignment with medical benefits and policies… more