- 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 ... med surg or specialty area. + Managed Care experience preferred, especially Utilization Management . + Preference for those residing in EST and CST zones.… more
- Humana (Annapolis, MD)
- …a part of our caring community and help us put health first** The Utilization Management (UM) Director, Clinical Strategy and Practice for Medicaid builds ... of how organization capabilities interrelate across the function or segment. The Utilization Management (UM) Director, Clinical Strategy and Practice for… more
- Evolent (Annapolis, MD)
- …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and client policies and ... the culture. **What You'll Be Doing:** The Evolent Appeals Nurse team offers candidates the opportunity to make a...and regulations. * Practices and maintains the principles of utilization management and appeals management … 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. Responsible for ... to obtain informed consent from study participants. + Remain proficient in the utilization of commonly used clinical protocols and guidelines. + Remain abreast of… more
- Sharecare (Annapolis, MD)
- …total healthcare management and ensure cost effective, appropriate resource utilization and quality outcomes. The Clinical Registered Nurse is also ... the participants and their Primary Care Provider according to the disease management program intervention guidelines. A Clinical Registered Nurse is supervised… more
- CVS Health (Annapolis, MD)
- …Skilled Nursing (SNF) and Assisted Living (ALF) facilities. The Clinical Nurse Specialist/Infusion Educator for LTC (Long Term Care) will work collaboratively ... of the work week are considered office days to plan visits. The Clinical Nurse Specialist/Infusion Educator LTC is responsible for the below, most of which must be… more
- Highmark Health (Annapolis, MD)
- …Nursing **EXPERIENCE** **Required** + 7 years in any combination of clinical, case/ utilization management and/or disease/condition management experience, or ... on where clinical care is being provided. **Preferred** + Certification in utilization management or a related field + Certification in Case Management … more
- Elevance Health (Hanover, MD)
- …required.** The **Telephonic Nurse Case Manager I** is responsible for care management within the scope of licensure for members with complex and chronic care ... **Telephonic Nurse Case Manager I** **Location:** This role enables...claims or service issues. + Assists with development of utilization /care management policies and procedures. **Minimum** **Requirements:**… more
- Lincoln Financial (Annapolis, MD)
- …Care, Orthopedics, Coronary Care, , Trauma , Disability, Workman's comp or case management or Utilization review **Application Deadline** **What's it like to ... Role at a Glance** We are excited to bring on a highly motivated Nurse Disability Consultant to our clinical organization. This position will be responsible for… more
- Evolent (Annapolis, MD)
- …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and ... **What You Will Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to company policies and… more
- Fresenius Medical Center (Lanham, MD)
- …staff training, equipment, physician and patient relations, cost containment, supply management , medical records, patient billing, OSHA and all company, state and ... by working with the Vice President of Quality and other organization management to ensure that organization/ASC policies and procedures are followed. + Responsible… more
- United Therapeutics (Annapolis, MD)
- …for which transplant is not currently an option. Who you are You are experienced nurse and an expert in all things PAH. You love providing mentorship, coaching and ... make a difference. The Regional Field Director, RNS Program Management serves as a director of all clinical field...+ Plan, collaborate, create and produce the yearly Clinical Nurse Summit meeting for HCPS across the United States… more
- Humana (Annapolis, MD)
- …**Key Functions:** **Strategic Planning and Implementation:** + Develop and implement utilization management strategies that align with organizational goals. + ... care. **Cost Containment:** + Identify opportunities for cost savings through effective utilization management practices. + Monitor and analyze utilization … more
- Sunrise Senior Living (Bowie, MD)
- …per state regulations. + A minimum of two (2) years' experience in a nurse management position within a skilled nursing environment including hiring staff, ... The Director of Nursing Services is responsible for providing leadership and management to the skilled nursing operations. Responsible for planning, organizing and… more
- BAYADA Home Health Care (Towson, MD)
- …leaders in the visit offices in effective execution of: episodic case management , high quality clinical care, and professional development for the clinical team. ... a current license in good standing as a Registered Nurse or Therapist in the state of practice. +...OF CLINICAL OPERATIONS:** + Demonstrated expertise in episodic case management , high quality clinical service delivery, and multidisciplinary team… more
- Evolent (Annapolis, MD)
- …identifies and refers quality issues to the Senior Director of Medical Management or Medical Director. + Appropriately identifies potential cases for Care ... Management programs + Communicates appropriate information to other staff...as assigned. **Qualifications: Required and Preferred:** + Licensed registered nurse or LVN/LPN (current and unrestricted) + Minimum of… more
- Highmark Health (Annapolis, MD)
- … **SKILLS** + Deep Clincal Expertise -extensive knowledge of clinical, quality, care, utilization , high-cost claim, and population health management . Must be a ... in Business or Clinical field **LICENSES or CERTIFICATIONS** **Required** + Registered Nurse (RN) or Pharmacist (Pharm D) or Physician Assistant (PA) **Preferred** +… more