- Elevance Health (Hanover, MD)
- ** Nurse Reviewer I** **Virtual:** This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing ... rotating weekends.** **New Grads are encouraged to apply!** The ** Nurse Reviewer I** will be responsible for...that are routine having limited or no previous medical review experience requiring guidance by more senior colleagues and/or… more
- Evolent (Annapolis, MD)
- …mission. Stay for the culture. **What You'll Be Doing:** The Nurse Practitioner/Physician Assistant (ARNP/NP/PA) Cardiology is responsible for support and assistance ... with the Director of UM to ensure client satisfaction. Perform all peer clinical review activities while located in a state or territory of the United States. Acts… more
- CVS Health (Annapolis, MD)
- …it all with heart, each and every day. **Position Summary** The Quality Management Nurse (QM Nurse ) supports Aetna Better Health of Texas by ensuring compliance ... clinical expertise with quality improvement leadership, including clinical documentation review , Performance Improvement Projects (PIPs), ANE oversight, and policy… more
- Gentiva (Beltsville, MD)
- …Partnerships. Transform Hospice Care.** We are seeking a dedicated Hospice Nurse Practitioner to perform Face-to-Face (F2F) encounters essential for hospice ... per hospice policy and regulatory requirements. + Communicate clinical findings, review treatment plans, lab results, diagnostics, and medications with certifying… more
- AccentCare, Inc. (Columbia, MD)
- Overview Nurse Practitioner / NP, Palliative Care Location: Columbia, MD Position: Nurse Practitioner Palliative Care Job ID: 71629 Remote/Virtual Position : No ... areas Find Your Passion and Purpose as a PRN/Part-Time Nurse Practitioner / NP, Palliative Care Salary: $38.00 -...with the supervisory physician (s) and attending physician to review patient records and care plans on a routine… more
- Humana (Annapolis, MD)
- …and help us put health first** The Utilization Management Behavioral Health Nurse 2 utilizes clinical nursing skills to support the coordination, documentation and ... and/or benefit administration determinations. The Utilization Management Behavioral Health Nurse 2 work assignments are varied and frequently require interpretation… more
- CVS Health (Annapolis, MD)
- …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 license in their...levels of care. + 1+ years' experience in Utilization Review . + CCM and/or other URAC recognized accreditation preferred.… more
- BioLife Plasma Services (Forestville, MD)
- …Center Manager and will perform as a Medical Support Specialist (Plasma Center Nurse ) to support plasma center operations. BioLife Plasma Services is a subsidiary of ... determine donor eligibility to donate plasma, management of donor adverse events, review of laboratory test results, and donor notification of unsuitable test… more
- Cognizant (Annapolis, MD)
- …to Friday - Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced level work related to clinical ... as well as timely filing deadlines and processes. . Review clinical denials including but not limited to referral,...have to be considered** . Educational background - Registered Nurse (RN) . 2-3 years combined clinical and/or utilization… more
- Amergis (Bowie, MD)
- We are seeking a compassionate anddetail-oriented Nurse Practitioner (NP) to join our team insupporting disabled veterans through the Veterans BenefitsAdministration ... disability examinations for veterans in accordance with VBA guidelines. + Review medical records and document findings using standardized templates. + Conduct… more
- Elevance Health (Hanover, MD)
- **Clinical Fraud Investigator II - Registered Nurse and CPC - Calrelon Payment Integrity SIU** **Location:** This role requires associates to be in-office 1 - 2 days ... opportunities for fraud and abuse prevention and control. + Review and conducts analysis of claims and medical records...Skills, Qualifications, and Experiences:** + Fraud and Abuse experienced Nurse with a CPC are highly desired. For candidates… more
- Surgery Care Affiliates (Columbia, MD)
- …you join our team, they will. Responsibilities We are actively hiring for an Registered Nurse (RN) PreOp PACU. + Promote the mission, vision, and values of SCA . + ... to care. + Delegate tasks according to the state Nurse Practice Act (if applicable), state board of nursing...with other disciplines as needed. + Participate in quality review and performance improvement projects. + Participate in the… more
- Datavant (Annapolis, MD)
- …+ 3+ years of clinical experience in an academic medical center + Registered Nurse license, Bachelor's degree in Nursing + CCDS or CDIP certification required + Must ... protected status. To learn more about our commitment, please review our EEO Commitment Statement here (https://www.datavant.com/eeo-commitment-statement) . Know Your… more
- Fresenius Medical Center (Annapolis, MD)
- …auditing activities. + Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. + Manages clinic ... including efficient utilization of supplies or equipment and regular profits and loss review . + Responsible for all required network reporting and on-site state or… more
- CVS Health (Annapolis, MD)
- …through integration. - Through the use of clinical tools and information/data review , conducts an evaluation of member's needs and benefit plan eligibility and ... facilitates integrative functions as well as smooth transition to programs and plans. - Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care… more
- CenterWell (Annapolis, MD)
- …actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that ... focuses on excellent service to others. **Use your skills to make an impact** **Required Qualifications** + Active unrestricted RN license with the ability to obtain Compact Nursing License + A minimum of three years clinical RN experience; + Prior clinical… more
- Highmark Health (Annapolis, MD)
- …to appropriate resources for additional support. + Implement care management review processes that are consistent with established industry, corporate, state, and ... federal law standards and are within the care manager's professional discipline. + For assigned case load, create care plans to address members' identified needs, remove barriers to care, identify resources, and conduct a number of other activities to help… more
- CVS Health (Annapolis, MD)
- …criteria or have a potential quality of care issue to a physician reviewer . - Identify and address quality issues and participates in quality management activities. ... the job functions. **Required Qualifications** - 5+ years' experience as a Registered Nurse with hospital experience; preferably in the specialty. - A Registered … more
- Datavant (Annapolis, MD)
- …Prevention Specialist is to effectively defend utilization of available health services, review of admissions for medical necessity and necessity of continued stay ... expertise successfully. Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well versed in...letter Identification of referrals to the medical director for review + Select appropriate preferred and contracted providers +… more
- Fresenius Medical Center (Lanham, MD)
- …dialysis therapy for patients under the direct supervision of a licensed nurse in accordance with organization policies, procedures, and training and in compliance ... significant information and/or change in patient condition directly to the registered nurse or supervisor. + Observe patient and conduct machine safety checks… more