- 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
- 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)
- …reviewers are supported by Physician clinical review staff (MDs) in the utilization management determination process. **What You Will Be Doing:** + Reviews ... Stay for the culture. **What You'll Be Doing:** Clinical Reviewer , Physical Therapy As a Clinical Reviewer ,...Therapy you will be a key member of the utilization management team. We can offer you… 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
- Evolent (Washington, DC)
- …the mission. Stay for the culture. **What You'll Be Doing:** **Cardiovascular Utilization Management Reviewer (Interventional Cardiologist)** Are you ready ... on patient care in a non-clinical setting? Join our Utilization Management team as a Field Medical... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more
- Koniag Government Services (Germantown, MD)
- …weapons design, nuclear material production, counterintelligence, weapon science, and military utilization of nuclear weapons to review and assess documents. ... Services, LLC,** a Koniag Government Services company **,** is seeking a Document Reviewer Level 5 (DRL5) with Top- Secret clearance to support **KPS** and our… more
- Koniag Government Services (Germantown, MD)
- …Professional Services** , a Koniag Government Services company, is seeking a Document Reviewer Level 2 (DRL2) with a Top-Secret clearance to support KPS and our ... Services, a Koniag Government Services company, is seeking an experienced Document Reviewer Level 2 (DRL2) to conduct classification reviews of documents and… more
- Koniag Government Services (Germantown, MD)
- …Professional Services** , a Koniag Government Services company, is seeking a Document Reviewer Level 1 (DRL1) with a Top-Secret clearance to support KPS and our ... Services, a Koniag Government Services company is seeking an entry-level Document Reviewer Level 1 (DRL1) to conduct classification reviews of government agency… more
- Koniag Government Services (Germantown, MD)
- …Professional Services** , a Koniag Government Services company, is seeking a Document Reviewer Level 3 (DRL3) with a Top-Secret clearance to support KPS and our ... Services, a Koniag Government Services company, is seeking an experienced Document Reviewer Level 3 (DRL3) to conduct classification reviews in accordance with… more
- Elevance Health (Washington, DC)
- …to clients/ members. The medical director provides clinical expertise in all aspects of utilization review and case management . Provides input on the ... means that the medical director is directly involved in Utilization Management and Case Management ....state or territory of the United States when conducting utilization review or an appeals consideration and… more
- Evolent (Washington, DC)
- …As a Vascular Surgery, Field Medical Director you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality… more
- Evolent (Washington, DC)
- …Doing:** As a Cardiology, Field Medical Director you will be a key member of the utilization management team. We can offer you a meaningful way to make a ... utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality… more
- Koniag Government Services (Germantown, MD)
- …Services, LLC,** a Koniag Government Services company, is seeking a Lead Document Reviewer Level 5 (DRL5) with Top- Secret clearance to support **KPS** and our ... design, nuclear material production, counterintelligence, weapon science, and military utilization of nuclear weapons. **Essential Functions, Responsibilities & Duties… more
- Ivyhill Technologies LLC (Bethesda, MD)
- …an Associate's Degree and a minimum of 2 years of experience in Utilization Management , Referral Management , Authorization/Denials, or Medical Claims ... to non-network providers to TRICARE Service Center for medical necessity/appropriateness review . + Routinely monitors referral management voicemail to ensure… more
- Trinity Health (Silver Spring, MD)
- …of hospitalization, LOC status, LOS management , continued stay decisions, clinical review of patients, utilization review activities, resource ... Accreditation: Maintains knowledge of regulatory and accreditation requirements related to utilization review (UR) LOC and clinical documentation. **5.** Revenue… more
- Evolent (Washington, DC)
- …Field Medical Director, Physical Medicine and Rehab you will be a key member of the utilization management team. We can offer you a meaningful way to make a ... utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality… more
- Evolent (Washington, DC)
- …**What You'll Be Doing:** As a FMD, Radiology you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality… more
- Evolent (Washington, DC)
- …Doing:** As a Field Medical Director, Oncology, you will be a key member of the utilization management team. We can offer you a meaningful way to make a ... utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality… more
- Humana (Washington, DC)
- …. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial ... 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